Home-Delivered Meal Program Referral Form

Eligible applicants must be age 60 or over, homebound, unable to drive/utilize public transportation, leave their home independently, unable to shop and/or prepare a nutritious, and not be attending a day-time program (e.g., dining program, adult day care program, etc.).*

Click the link below for a printable form


*An individual under the age of 60 may be eligible with an approved waiver (DHS, PACE, Rhody Health, etc.)

Step 1 of 3 - Person Making the Referral

  • Person Making Referral

  • Client Information

  • Date Format: MM slash DD slash YYYY