Meals on Wheels Application | City of Happy Valley

Meals on Wheels volunteers have received background checks and training prior to delivery.

The cost of each meal is $7.39.
Participants are asked to contribute to the cost of the meal.
Participants must be at home to receive meals.
Please request meals when you are ready to receive them.

How to request Meals on Wheels service:

Complete the form below. The City of Happy Valley Parks and Recreation staff will contact you to review your eligibility in the program. To discuss your eligibility or for more information, please call 503-783-3819.

NOTE: To request a call to discuss the home-delivered meals program, please fill out the form below and we will contact you as soon as possible.

Meals on Wheels

REQUESTOR INFORMATION
Name*
Your First Name Your Last Name
Your Phone Number*
Your Email Address*
Your Relationship to Client/Recipient
PARTICIPANT INFORMATION
Name*
First Name Middle Name Last Name
Date of Birth*
Address*
Street Address Apartment Community and Apartment Number (if applicable) City State ZIP Code
Phone*
Alternate Phone
Primary Language (if other than English)
Does the participant know meals are being requested?*
- Yes
- No
Does the participant have a Medicaid / COPES case manager?*
- Yes
- No
Name of Case Manager
First Name Last Name
Phone Number of Case Manager
Emergency Contact Information
Name
Emergency Contact First Name Emergency Contact Last Name
Emergency Contact Phone
Relationship to Participant
Name
This field is for validation purposes and should be left unchanged.

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Meals on Wheels volunteers have received background checks and training prior to delivery.

Meals on Wheels

REQUESTOR INFORMATION

PARTICIPANT INFORMATION

Emergency Contact Information

City of Happy Valley

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16000 SE Misty Drive, Happy Valley, OR 97086

(503) 783-3800 | info@happyvalleyor.gov