Recipient Application | Haywood County Meals on Wheels

Apply for Meals!

If you are interested in applying to recieve Meals on Wheels for yourself or a loved one, please continue to the form below. As a reminder, those who qualify for our program are:

Ages 60 and above.
Cannot prepare meals for themselves and do not have someone who can prepare meals for them.
Are homebound, no longer drive themselves, and/or rely on others for transportation needs.

Click here to find more information about our eligibility requirements. Please note that there must be an assessment performed to start service, and that there may be a delay between form submission and assessment date.

Recipient Information:

Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Birthday

Home Phone:

Cell Phone:

Are you homebound?

Our homebound definition - one or more could apply to you:

Not driving
Driving very little only in emergency
Only drive to get to doctor appointment
Would drive less if I had home delivered meals
Only drive in necessity and would be safter if I didn't drive

Yes

Describe what's making it hard to prepare your meals?

Do you live alone?

Yes

Do you live with someone who can prepare your meals?

Yes

If you live with someone, do they struggle to prepare meals due to physical and/or mental health needs?

Yes

Additional Comments:

Emergency Contact Information

Name:

Phone:

Relationship to you:

Confirm Email

Describe the outside of your home and any landmarks/stores you live near so volunteers can better find you.

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