Apply for Services

Applications for Cabarrus Meals on Wheels are welcomed from anyone.  If you know of anyone who may be in need of this service, please fill out the form below or call our office at 704-932-3412.

First name (*)

Please let us know your first name.

Last Name (*)

Please let us know your last name.

Street Address

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City

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State

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Zip

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Work Phone

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Home Phone

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Email (*)

Please let us know your email address.

What is your relationship to the applicant in need of a service?

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Date of Birth

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Brief directions to home:

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Choose one of the following options:
Homebound
Unable to Cook
Unable to Shop
Lives Alone

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Referred by: (Please include agency name, contact, and phone number)

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Security Code


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