Meals on Wheel Application

The next step in the Meals on Wheels eligibility process is to fill out the Meals on Wheels application. Before you start the application, make sure you have your income and benefits information handy.

Once your application is submitted, a local care manager will contact you via the mail on next steps. Care managers are located in your community. You may be contacted by someone from Feed More, the Span Center or Crater District to ensure you have access to the resources available to you.

The application below will take about 15 minutes to fill out. If you need a printed application, you can download it here and mail it to Feed More’s Meals on Wheels.

Applicant Information

Please complete the following information about the meal recipient (only one person per application).

Applicant's Name

First

Last

Applicants's Date of Birth

Applicant's Address

Address Line 1

Address Line 2

City

State

Zip Code

Recipients of Feed More's Meals on Wheels must reside in the following areas of Virginia: the cities of Richmond, Petersburg, Colonial Heights or Hopewell, or the counties of Charles City, Chesterfield, Dinwiddie, Goochland, Hanover, Henrico, Louisa, New Kent, Powhatan or Prince George.

What county do you live in?

Applicant's Phone Number

Applicant's Email Address

Applicant's Gender

Applicant's Race/Ethnicity

Applicant's Veteran Status

Referral Information

This section is for the Individual or Agency filling out the application.

What is your relationship to the applicant?

Referral Name

First

Last

Referral Address

Address Line 1

Address Line 2

City

State

Zip Code

Who should receive the confirmation letter to schedule an intake phone call?

Applicant
Referral Contact
Emergency Contact

Emergency Contacts

Please list those we can discuss the recipient's well being with or contact for emergency purposes.

Emergency Contact 1 Name

First

Last

Relationship to Recipient

Emergency Contact Phone Number

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact 2 Name

First

Last

Relationship to Recipient

Emergency Contact 2 Phone Number

Emergency Contact 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Cost of Meal Service

Feed More’s Meals on Wheels service fee is assessed based on the applicant’s income and monthly expenses, using a sliding scale. A limited number of sponsorship opportunities are available through the Span Center, the Crater District Area Agency on Aging, or directly through Feed More. Meals on Wheels also accepts SNAP (also known as food stamps) for payment. Applicants may request a reduced or waived service fee and will be required to provide additional information to support their request. No one will be turned away based on income.

Do you receive SNAP benefits?

Do you receive Medicaid benefits?

What is your estimated monthly income?

What is your estimated total of monthly expenses?

Living Arrangements and Homebound Status

Is the recipient able to leave home for appointments with assistance?

The recipient is able to leave home for appointments with assistance.
The recipient is unable to leave home.

Please select the description that best describes the applicant's help at home.

I have a caregiver (family/friend) or personal care aide who is unable to prepare meals.
I have a caregiver (family/friend) or personal care aide who prepares meals.
I have no other reliable way to obtain daily meals

By completing this form, applicant certifies that consent is given for Feed More’s Meals on Wheels to share information with partner agencies. Applicant may be contacted by a partner agency to be screened for home delivered meals.

I agree

Meals on Wheel Application

Applicant Information

Referral Information

Emergency Contacts

Cost of Meal Service

Living Arrangements and Homebound Status

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