Find Center
FeedNeed a Meal

Home Delivered Meal Program Application

Apply for home delivered meals.

Complete this application for yourself or someone you care for. It takes about 10 minutes, and required fields are marked with an asterisk.

Primary eligibility requirements

  • Homebound with little or limited ability to drive
  • Unable to prepare midday meals independently
  • Limited support from others who can provide a midday meal

Space is limited. Applicants are added based on need and as space becomes available.

Section 1 of 4

Applicant Information

Are you over 60? *
Veteran? *

Section 2 of 4

Emergency Contact & Service

Duration of services requested *

Section 3 of 4

Home & Meal Preparation

Do you live alone? *
Can you drive safely? *
How would you rate your ability to prepare meals? *
Can you use a microwave? *
Can you use a stove? *
Who in the home can prepare meals? *

Section 4 of 4

Community Connection

Would you like more social interaction? *
Would you attend Young at Heart if transportation is provided? *

Private and secure

Submit application

Our Client Services team will review your answers and contact you about an assessment.

Prefer paper? The downloadable application remains available on the Programs page.

By submitting, you agree to be contacted by PCMOW about this application. See our Privacy Policy. This site is protected by reCAPTCHA for spam, fraud, and abuse prevention.

Back to Programs