Meals on Wheels South Florida

Upon completion of this form, our Social Work Department
will be following up with you as soon as possible.

If you would like to speak with our Social Work Department
to complete this form over the phone, please call 954.714.6946.

Note: If you leave an email, you will receive an email notification
that your application was received. If you do not leave an email, you will not.

Apply for Meals

Name of person making application

Your Phone Number

Your relationship to applicant

Professional agency or affiliation

Name of applicant

Street Address

City, State, Zip

Phone

Date of Birth

Gender

Race

Ethnicity

Primary Language Spoken

Marital Status

Living Situation

Is there a caregiver in the household?

Does applicant need assistance evacuating in case of a hurricane?

Are they registered with Broward County Special Needs registry?

Monthly Income

Is applicant receiving food stamps?

Estimated Assets

Is this person aware of the referral?

Does this person have enough money to buy the food they need?

Is this person able to handle preparing frozen meals?

Please add additional comments/concerns below.

Is this person homebound?

Thanks for submitting! We will get back to you as soon as possible!

Upon completion of this form, our Social Work Department
will be following up with you as soon as possible.

If you would like to speak with our Social Work Department
to complete this form over the phone, please call 954.714.6946.

Note: If you leave an email, you will receive an email notification
that your application was received. If you do not leave an email, you will not.

Apply for Meals

Our Mission: Ending hunger across all ages with kindness, dignity and compassion

Main: 954.731.8770

Office Hours:
M-F from 8-4

​

Upon completion of this form, our Social Work Department will be following up with you as soon as possible.

If you would like to speak with our Social Work Department to complete this form over the phone, please call 954.714.6946.

​

Note: If you leave an email, you will receive an email notification that your application was received. If you do not leave an email, you will not.

Apply for Meals

Our Mission: Ending hunger across all ages with kindness, dignity and compassion

Main: 954.731.8770 Office Hours: M-F from 8-4

Upon completion of this form, our Social Work Department
will be following up with you as soon as possible.

If you would like to speak with our Social Work Department
to complete this form over the phone, please call 954.714.6946.

Note: If you leave an email, you will receive an email notification
that your application was received. If you do not leave an email, you will not.

Main: 954.731.8770

Office Hours:
M-F from 8-4