Senior (62+) Disabled Food Access Program Intake
Thank you for your interest in this exciting new program St. Vincent de Paul is proud to offer our Senior (62+) and disabled residents of the community. Our Food Access Program is designed to provide participants with delivery of a food box (containing food for 3-5 days) along with a hot meal every 14 days. This is a new program so please be understanding with 
Registration Form for Food box and Meal Delivery Program 2024 to 2025 - Formulario de Registro para el Programa de Entrega de Cajas de Alimentos y Comidas 2024 a 2025
Please be sure to complete all required fields, an incomplete application may delay your registration. If you need assistance in completing this form please contact Becca, Social Services Manager; at (530)599-0274.



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Name:  (Last, First) *
Date of Birth: *
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DD
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Is your accessibility to food limited due to any of the following (select all that apply): *
Required
If selected for the food access program which day and time would best suit you (please select one):
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Gender Identity: *
Required
Address:  1234 Main St, County, City, State, Zip Code *
Phone Number: *
Email Address:
Housing Type: *
What language(s) are spoken in your household: *
What is your Race or Ethnicity: *
Do you have a disability: *
What is your household's primary income: *
Does anyone in the household receive SNAP (food stamps) benefits:
Clear selection
Does anyone in your household have any Dietary Considerations:
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