Apply for Meals | Meals on Wheels Orange County

Apply for Meals

To apply for meals for yourself or another person, please fill out the form on this page. Please note that Meals on Wheels Orange County NC has a waitlist for service. We encourage potential recipients or those who refer potential recipients to still apply for meals.

Need to learn more about our services, your eligibility, or our fees before you apply? Click here.

Want to see an example menu? Click here.

Application Form

Your First Name

Your Last Name

Your Telephone Number

Your Email Address

Confirm your email address

Who Are You Referring?

Your Birthdate

Your Street Address - 1

Your Street Address - 2

Your City

Your State

Your ZIP Code

Tell Us Why

Anything Else We Should Know

Referral's First Name

Referral's Last Name

Referral's Birthdate

Referral's Telephone Number

Referral's Street Address - 1

Referral's Street Address - 2

Referral's City

Referral's State

Referral's ZIP Code

Your Relationship

Reason for Referral

Other Information We Should Know

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