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Please proceed if you meet the following requirements:
You must consent that your information will be sent to the County who will be coordinating services and to the State and FEMA who are funders of the program, AND
You are NOT currently receiving assistance from Cal-Fresh and/or receiving Home Delivered Meals, AND
You confirm that the information you have provided is accurate and true.
Also you need to meet 1 OR 2 OR 3 below:
1. You are 65 or older, OR 60 - 64 years old and been exposed to someone with COVID, OR 60-64 years old and a high-risk individual.
2. You live alone. Your income is below $74,940. You are not able to prepare or obtain meals on your own.
3. You do NOT live alone. Your income is below $101,460. You are not able to prepare or obtain meals on your own.
If you do NOT consent, please do NOT proceed.
If you are currently receiving assistance from Cal-Fresh and/or receiving Home Delivered Meals, please do NOT proceed.
Date of Birth
Date Format: MM slash DD slash YYYY