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Senior Nutrition Program - Meals on Wheels Referral Form

Last modified: 11/8/2013 2:01 PM

If you are seeking meal assistance for yourself or for an elderly friend or relative, please call 408-350-3246 for a confidential eligibility assessment or complete and submit the referral form below.

Eligibility Criteria:

  • 60 years of age or older
  • Living in Santa Clara County
  • Homebound (unable to purchase food and/or cook
  • food on a consistent basis and doesn’t have someone else able to do so)

Please NOTE: This program serves people living in Santa Clara County, CA. If the person needing meals lives outside of Santa Clara County, CA please click here to find the appropriate meal delivery program. You will be redirected to the Meals on Wheels Association of America website where a complete listing of Meals on Wheels programs is available.

Santa Clara County Meals on Wheels is administered in partnership between the County of Santa Clara and Sourcewise.

 

Person requesting information or making a referral:
Information about the person who needs Meals on Wheels: (Please note that most fields below are required)