Dear Project Chicken Soup Client,
Thank you for inquiring about Project Chicken Soup home
kosher meal deliveries for people living with HIV/AIDS, cancer or other serious illnesses. Below you will find forms which we must have for our records in order to begin your enrollment process.
We require documentation from the clients whom we serve in order to apply for funding and to maintain our non-profit 501-c-3 status. In addition, it will also be very helpful for us to know more about all our clients in order to help us plan future service delivery. Toward this end, we ask you to complete the Client Intake Form.
We also find that, on occasion, we encounter problems with deliveries to clients who do not understand that we are a volunteer organization, and we work efficiently only when we can count on our clients to be serious about our schedule. Consequently, we are asking that everyone sign the enclosed Service Delivery Agreement.
Please have the Physician Statement of Diagnosis Form completed by your doctor and return to us with the Client Intake Form and the Service Delivery Agreement.
If you have any questions, please feel free to call us at 310-836-5402 or email us at ClientServices@projectchickensoup.org.
The Client Application Package includes the following forms:
Application (to be completed by client)
Service Delivery Agreement (to be completed by client)
Physician Statement of Diagnosis (to be completed by physician)
Downlad the enire packet here
The Application Packet is in Adobe PDF format.
If you do not have Adobe Acrobat download it
here for free.