Services - Apply for the Service

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 704-788-3412.

First Name
Last Name
Street Address
City
Zip
Work Phone
Home Phone
E-mail

Please identify and describe yourself:

Date of Birth

Brief directions to home:

Choose one of the following options:

Homebound
Unable to Cook
Unable to Shop
Lives alone

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

Security Code:

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Services - Apply for the Service