Meals on Wheels for Santa Cruz County logo

Meals on Wheels Client Application

Home Delivered Meals

* Required

Thank you for your interest in receiving meals from Meals on Wheels for Santa Cruz County! We provide meals to more than 1,300 seniors throughout Santa Cruz County each year.

If you do not live in Santa Cruz County or are applying for someone who does not live in Santa Cruz County, please visit the Meals on Wheels America directory and search for your local provider: mealsonwheelsamerica.org/find-meals

Meals on Wheels for Santa Cruz County serves only those aged 60 and older. If you are under 60, please visit cdss.ca.gov/food-banks for food assistance or communitybridges.org/frc/ for additional services.

Please complete one application for each person who is applying.

Select date MM slash DD slash YYYY
Are you 60 or older?*

Client Information

If you do not live in Santa Cruz County or are applying for someone who does not live in Santa Cruz County, please visit the Meals on Wheels America directory and search for your local provider: mealsonwheelsamerica.org/find-meals

Emergency Contact Information

Referral Information (Optional)

Demographic Data

Gender*
Low Income*
Lives Alone*
Veteran*
Spanish Speaker Only
Receives SSI*
Receives MediCal*
Are You Disabled?*

If you do not live in Santa Cruz County or are applying for someone who does not live in Santa Cruz County, please visit the Meals on Wheels America directory and search for your local provider: mealsonwheelsamerica.org/find-meals

This field is for validation purposes and should be left unchanged.
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