Apply for Program

Please complete this form to apply for Meals on Wheels in Terre Haute.  We will contact you soon.

In the meantime, you can also submit payment for meals online.

Meal Recipient

We like to get 2 weeks of payments to begin meal service. How do you wish to pay?

Once you submit this form, you will be redirected to a payment page to pay for meals if you chose that option.  Thank you.

Emergency Contact

Delivery Instructions

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.