Senior Food Box Client Application

If you are an elderly adult in need of food help, you can apply for a monthly Senior Food Box. Please take a moment to review the eligibility requirements for this program:

  • You must be 60 years of age

  • The food is shelf stable and there is some simple cooking involved, so you will need access to basic cooking facilities

  • You or an authorized representative should be able to pick up your food box from a pickup location

If you’d like to apply to receive a monthly Senior Food Box, please fill out and submit the application below and our team will be in touch to discuss next steps.

If you are not eligible for this program but you still need help, please fill out our Contact Form or call our office at 706-736-1199 and our team will work to connect you with the food resources that fit your needs.

"*" indicates required fields

Date of Birth*
Authorized Representative
I authorize the following individual(s) to pick up my food box on my behalf if I become ill or unable to pick up the food on my own.
First & Last Name #1
First & Last Name #2
Client's Signature*
Please enter your first and last name. Filling out these fields and submitting this form constitutes your digital signature to the above information.
This field is for validation purposes and should be left unchanged.

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