Is the applicant over the age of 65 or immunocompromised? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Due to COVID-19, we are currently limiting new enrollments to those who are over the age of 65, or are immunocompromised and living alone. If you are under the age of 65 and in need of food, please contact:
Is the applicant, or someone else, able to come to the door when meals are delivered? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Due to risk of transmission of COVID-19, volunteers are unable to enter residences. Please locate someone who can answer the door during delivery and then re-start the application process.
Is the applicant or someone else in the house currently experiencing symptoms of COVID-19, or has the applicant or someone else in the house tested positive for COVID-19 within the last 14 days? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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What is the applicants zip code? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Edmond Mobile Meals service area covers Edmond zip codes. To find your local meal program, visit Meals on Wheels of America at the link below and enter your zip code.
Is the applicant homebound? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Edmond Mobile Meals service is reserved for the homebound elderly and disabled residents of Edmond who are unable to prepare a meal for themselves and do not have a caregiver during the daytime. A homebound individual is defined as someone who does not normally leave their home, cannot drive and unable to shop for groceries or go to restaurants. Service cannot be provided due to: financial constraints or not having a vehicle.
Visit these resources for programs that may be a fit for your circumstance:
Does the applicant have a caregiver or assistance during the daytime, Monday - Friday? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Edmond Mobile Meals service is reserved for the homebound elderly and disabled residents of Edmond who are unable to prepare a meal for themselves and do not have a caregiver during the daytime. A homebound individual is defined as someone who does not normally leave their home, cannot drive and unable to shop for groceries or go to restaurants. Service cannot be provided due to: financial constraints or not having a vehicle.
Visit these resources for programs that may be a fit for your circumstance:
Are you making this application on behalf of yourself or someone else? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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What is your relationship to the applicant? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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How is the applicant currently getting meals? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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What else can you tell us about the applicant's situation that will help us in assisting them? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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APPLICANT: GENERAL INFORMATION
Name {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
Other Phone [include area code] {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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MEAL INFORMATION
Effective January 5, 2021 Edmond Mobile Meals will offer additional service offerings. Please check which services you would like to receive.
Tuesdays: Hot meal (request for clients to contribute for this meal)
Wednesdays: 5 days of frozen meals, salad, fruit, side items & milk (no charge to clients at this time)
Thursdays: Hot meal (request for clients to contribute for this meal)
Continue with Application? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Would the applicant like to receive a carton of 2% milk with their meal? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Please provide special delivery instructions. {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Does the applicant have a working doorbell at their residence? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Please provide additional special delivery instructions. [security gate codes, call prior to delivering, etc.] {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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When would you like to begin meal delivery? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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FINAL APPLICATION DETAILS
Edmond Mobile Meals recommends a contribution of $3.50 per hot meal if doable. Please indicate what you are able to contribute. (We will send an invoice at the end of each month.) {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Should statements be sent to applicant or someone else? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Please send statements to:
Name {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
I understand that I may be eligible to receive this service on a temporary basis due to the covid-19 pandemic, and continuation of this service when normal meal operations resume is dependent upon meeting the usual program qualifications, and my status as a client will be reviewed at that time. Service may be discontinued if I do not meet those qualifications.
I understand and agree to these terms: {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
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Please tell us how you heard about Edmond Mobile Meals {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }