Application – Great Plates Program – Administered by Age Well

Great Plates Program - Administered by Age Well

In Orange County, Great Plates Delivered is funded in part through a grant from the California Office of Emergency Services, as allocated by the Orange County Board of Supervisors and administered by the Office on Aging.

You must meet all of the eligibility guidelines in order to qualify for this program.

Applicant Information

Are you the applicant?*

Yes
I am a friend, family member, or caretaker
I am from a company or agency

Please provide your name (or company/agency name) and phone number.*

Applicant Name*

First Last

Applicant date of birth:*

Applicant Address*

Street Address Address Line 2 City State ZIP Code

Applicant phone:

Applicant email:*

The applicant's email is a required field. Confirmation of this application will be sent to this email. If the applicant does not have an email, please use the email of a neighbor or friend.

Applicant Eligibility

Do you live alone?*

Yes
No, but I live with another adult who is also eligible. (Note that they will need to fill out their own application.)
No

Please enter your age. You must be over age 65 to be eligible for this program. Those aged 60-64 with existing medical conditions may also be eligible.*

65 or older
60 to 64
Under 60

Do you have one of the following existing medical conditions?*

Tested positive for COVID-19, as documented by a state/local public health offical or medical health professional, and do not require hospitalization but need isolation or quarantine (including those exiting from hospitals).
COVID-19 + Exposed, as documented by a state/local public health official or medical health professional, and do not require hospitalization but need isolation or quarantine.
Neither of these

Do you have one of the following existing medical conditions? Those aged 60-64 are eligible for the program if they have one or more of the following medical conditions.*

Are you able to prepare your own meals or independently purchase meals that could be delivered to you for delivery?*

Yes
No

Is your annual income less than $74,940 for a household of one (1) or $101, 460 for a household of two (2)?*

Yes
No

Do you currently receive or have you received in the last 30 days other federal and state nutrition programs, including CalFresh/SNAP or Older Americans Act Home Delivered Meals (Meals on Wheels) or Congregate Grab & Go frozen meals (through a senior or community center or other distribution location)?*

Yes
No

Do you have any support from family/caregivers/other who can assist with meal preparation?*

Yes
No

Great Plates Program - Administered by Age Well

Great Plates Program - Administered by Age Well

Applicant Information

Applicant Eligibility

Great Plates Program - Administered by Age Well

Dietary Restrictions

Delivery Information

Attestation