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Kupuna Meal Kit Registration - WAITLIST
*This program is now at full capacity. All applicants will be waitlisted.*

This intake form is being administered by Nourish Kauai, a program of Crossroads Christian Fellowship Church, a community nonprofit 501(c)3, in partnership with other Kaua'i nonprofits and community organizations.  

The purpose is to better understand community food needs and to identify Kupuna (elderly) who are in need of assistance. We will are providing meal kits so that kupuna in financial need are provided for and given nutritionally dense, locally sourced meals. Meal kits will have whole, raw ingredients. Meaning, nothing will be prepped, and the recipient will have to prepare and cook the meals themselves. Each person that qualifies for our program will receive a meal kit with raw groceries or ingredients.

Requirements of program:
✔︎65 years of age or older
✔︎Live in region between Anahola- Kaleheo (other organizations will be serving Kupuna in other areas of Kauai)
✔︎Live alone or with another Kupuna (will consider exceptions as needed)
✔︎Able to cook or have a caregiver able to cook
✔︎Max Household Income
   - 1 in Household: $57,100
   - 2 in Household: $65,250
   - 3 in Household: $73,400
   - 4 in Household: $81,550

We will consider exceptions to our requirements on case by case basis by vote of the board after interview with potential recipient.

Funding for this program has been provided through a generous donation from the Frank and Belinda Vandersloot Foundation!

Information provided will be used to coordinate meal delivery for the program length. If requested, this information may be be shared with our partners for the purpose of relief and aid.

Filling out this form does not guarantee enrollment in our program. We do have a max limit of Kupuna we can serve. Once we receive your form, we will notify you of availability/eligibility and delivery details, as applicable.

• I relinquish Nourish Kauai, Crossroads Christian Fellowship, and Nourish Kauai’s representatives and partners of any and all liability of any nature whatsoever and accept the food “AS IS” and at my own risk.
• There is no guarantee to the amount or type of food product given.
• Selling of food or products from boxes is prohibited

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I certify to the best of my knowledge that everything written in this application is true and correct. Please write out your full name below and the date today you are signing.  *
First Name *
Last Name *
Email address *
Phone number *
What is the best way to contact you? *
Do you live between Anahola to Kaleheo? *
Physical address for meal delivery, if needed *
Are you 65 years of age or older? *
Do you live alone or with another person 65 years of age or older? *
If you don't live alone or with another Kupuna, please explain why meal delivery is needed
Do you have any food allergies we should be aware of? If yes, please list in detail. We cannot guarantee allergy substitutions. *
Are you able to prepare meal kit on your own, or do you know of anyone who can prepare meal kit for you?
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Are you filling this form out for someone else? *
If you are filling this form our for someone else, please provide your Name, Email address and Phone number so we can contact you if needed
Is there anything else we need to know? Any delivery instructions or driving instructions?
I certify that everything written in this application is true to the best of my knowledge. Please sign your full name below *
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