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Food Angel Program Referral

Who Should Use This Form?


This form is for family, friends, health care workers, clergy, and community agencies who are concerned about a senior experiencing a food crisis.

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If you are a senior seeking support for yourself, please complete a Food Angel Application Form or call 519 539-9817.

Food Angel Referral Form

Instructions: To request assistance for another person, please fill out all fields below with their information. Pay special attention to mandatory items marked with an asterisk (*). Click 'Submit' when finished.

Person in Need's Information

Address for delivery

Multi-line address
Living Situation
Lives Alone
Lives with spouse/partner
Lives with caregiver/family
Other
Reason for Referral (check all that apply)
Estimated Length of Need
1 Week
1 Month
3 Months
6 Months or more
Not sure - Please assess

Applicants Information (Your's)

We are happy to help. If you have any questions about this program, please contact us.

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