Grocery Delivery Form | United Way of Central Georgia

Grocery Delivery Form

Eligibility Requirements:

i. 55 or older, disabled, high-risk due to underlying conditions (i.e. asthma, COPD, heart condition, etc.), and/or homebound with a medical condition requiring you to stay home due to COVID-19

ii. Have no family, friends or neighbors to go to a pantry or grocery store for you

iii. Must be able to cook for yourself, heat in the microwave, or have someone available to assist

iv. Must reside in one of the following 14 counties: Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Macon, Monroe, Peach, Putnam, Twiggs, Washington, or Wilkinson

If you are unable to fill out this form online, please call 478-365-2984

Name

Address

City

Zip code

Phone Number

How many individuals are in the home?

How many individuals in the home are under the age of 18?

List any allergies, religious, or dietary restrictions

Please tell us how you found out about this program (example: friend, 211, social media, etc.)

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