Cancer, ALS, MS, COPD, CHF, ESRD Application
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Diagnosed with cancer, MS, ALS, COPD, ESRD, CHF, HIV/AIDS
- Living in the Twin Cities metro or surrounding suburbs
Note: We do not qualify individuals based on income status.
How to Apply
You can conveniently apply via one of our secure online forms below. If you have any questions about the application process, please contact one of our Client Services representatives at 612-767-7333.
Ways to Apply
Download and print the pdf below to submit via mail or fax. Completed applications can be faxed to 612-872-0866 or mailed to our South Minneapolis building (c/o Client Services Department).
Please note: A signature from your medical provider, case manager, or social worker is required.
What Happens Next?
After we receive your completed application form, we will assess your eligibility and a member of our staff will contact you to set up menu and delivery details. If you are not eligible for services, our staff will assist you in finding other resources.
Questions? If you have any questions about the application process, please contact one of our Client Services associates at 612-767-7333.
