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2. Glenn Heights Meal Assistance Application
4. Name*
5. Email Address*
7. Address (Must be a Glenn Heights Resident)*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Number of People in Household*
16. Eligibility Requirement
18. Federal Worker Verification (upload either one):*
    • Federal Employee ID Badge
    • Recent Pay Stub or Earnings Statement
    • Federal Agency Letter Confirming Employment Status
19. Proof of Residency (upload either one):*
    • Driver’s License or State ID with Glenn Heights Address
    • Recent Utility Bill
    • Lease or Mortgage Statement
21. Meal Request
23. How many meals does your household need?*
24. Do you have any dietary restrictions or allergies? (Optional)*
26. Are you able to pick up meals from the Glenn Heights Community Center? *
    -- Select One --YesNo

    (Pickup Date & Time: To be announced)

28. I give the City of GLenn Heights permission to check the information I provided. I understand that meal assistance is limited and not guaranteed. I also understand that details about meal pickup will be shared once they're confirmed, and I agree to be contacted with updates.

    (PLEASE TYPE NAME AS FORM OF DIGITAL SIGNATURE)

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field