1. Are you 65 or older?
3. (a) Are you a high-risk person as defined below:
Chronic lung disease or moderate to severe asthma or Chronic kidney disease undergoing dialysis
Serious heart conditions
Immunocompromised (cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies,
poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications)
Severe obesity, Diabetes, Liver disease
3. (b) Have you been diagnosed COVID-19 positive
Been documented to have been exposed to COVID-19 by a
public health official or medical professional
* NOTE: If participant indicates they are COVID-19 positive, client will be contacted to obtain supporting
documentation. Without providing supporting documentation, you will not be eligible for the GPD program.
4. Are you currently receiving assistance from Cal-Fresh, and or receiving state/federal nutritional
program (Elderly Nutrition Program Congregate Meals or Home Delivered Meals)?
* Note: Reply “NO” if you were prior Long Beach Great Plates Delivered Program (GPD) meal recipient as this does not include receiving meals from Long Beach GPD.
5. Do you live alone or with one other individual who is also 65+ years of age,
or 60-64 years of age and at high-risk?
NOTE: If you live with one another individual who is also eligible for this program,
please note that each participant in a household must enroll individually.
6. Does your annual income exceed $74,940 (single) or $101,460 (2-person)?
7. Is your annual less than $25,520 (single) or $34,380 (2-person)? (Y/N) *
NOTE: Participants cannot makes less than 200% of the federal poverty limit)
8. Are you able to prepare or obtain meals on your own?
12. Address (where delivery will be made)
18. Please indicate your meal preference
select an option
19. By submitting this form, I certify under penalty of perjury that the information
provided in the application form is true and correct.
20. By clicking yes, you are providing consent to your information being sent to the County
who will be coordinating service and to the State and FEMA who are funders of the program?.