Social Care Network — New York

Social Care Network Screening

This free, confidential screening helps us connect your household with food, nutrition, and other services you may qualify for.

You & your household

Tell us who you are, where to deliver, and who else is eating.

First name*

Last name*

Home phone*

Cell phone

Email address (optional)

Delivery Address

Street address*

Apt / unit

City*

State*

ZIP*

Household

Count yourself plus anyone else who'll also receive meals — spouse, children, infants.

1just you

Medicaid

Medicaid is required to participate in this program — add each person's Medicaid ID below.

You (you)

Date of birth*

Medicaid ID (CIN)*