Home Delivery Application

Apply for our home food delivery service. We provide this accommodation for individuals unable to safely or reasonably access in-person food distribution.

Home Delivery Application

This application takes about 10 minutes to complete. We'll review your request and contact you within 3-5 business days.

Eligibility Information

Home delivery is available for individuals with mobility limitations, disability, chronic medical conditions, advanced age, lack of transportation, or caregiving responsibilities. You must meet TEFAP/EFAP income eligibility requirements and reside within our delivery area. No medical documentation required - self-attestation is sufficient.

Apply for Home Delivery

Please fill out all required fields

Client Information

Household Information

Transportation Access

Assistance at Home

Certification

Type your full legal name as your electronic signature

Need Help with the Application?

Email us: Send a message

We typically respond to applications within 3-5 business days. Priority is given to homebound seniors and individuals with disabilities when capacity is limited.