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This document is used to refer clients for home delivery services of food resources under the Extra Helpings Program, ensuring they meet eligibility criteria due to medical or urgent needs.

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How to fill out home delivery referral for

How to fill out Home Delivery Referral for the Extra Helpings Program

01

Obtain a Home Delivery Referral form from the Extra Helpings Program website or local office.

02

Fill out the personal information section, including your name, address, and contact information.

03

Indicate the reason for the referral by checking the appropriate box.

04

Provide details about the individual's dietary needs or restrictions.

05

Include any relevant medical information that may affect meal preparation.

06

Specify the preferred delivery schedule and any special instructions for delivery.

07

Review the completed form for accuracy and completeness.

08

Submit the form either online or in-person at the designated location.

Who needs Home Delivery Referral for the Extra Helpings Program?

01

Individuals who are homebound and unable to shop for or prepare meals.

02

Elderly individuals who may have difficulty accessing food.

03

People with chronic illnesses or disabilities that restrict mobility.

04

Families in need of assistance due to financial hardship or other crises.

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What is Home Delivery Referral for the Extra Helpings Program?

Home Delivery Referral for the Extra Helpings Program is a process designed to facilitate the delivery of food and essential items to individuals who have difficulty accessing them due to mobility issues or other reasons. It ensures that participants receive the necessary support to meet their nutritional needs.

Who is required to file Home Delivery Referral for the Extra Helpings Program?

Individuals who qualify for the Extra Helpings Program and require assistance with home delivery of meals or groceries must file a Home Delivery Referral. This includes seniors, disabled individuals, or those with health issues that prevent them from shopping in person.

How to fill out Home Delivery Referral for the Extra Helpings Program?

To fill out the Home Delivery Referral for the Extra Helpings Program, complete the designated referral form with accurate personal information, including the participant's name, address, and contact information. Specify the type of assistance needed and provide any relevant medical or social service information that supports the need for home delivery.

What is the purpose of Home Delivery Referral for the Extra Helpings Program?

The purpose of the Home Delivery Referral for the Extra Helpings Program is to ensure that individuals who are unable to shop for themselves can receive the necessary food and supplies directly at their homes. This program aims to improve their access to nutrition and support their overall well-being.

What information must be reported on Home Delivery Referral for the Extra Helpings Program?

The Home Delivery Referral must report the participant's full name, address, phone number, details of the required assistance, any medical conditions affecting their ability to shop, and the names of any caregivers or family members involved in the process. Additionally, it may include information about dietary restrictions or preferences.

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