Shopping List - Open Cupboard Food Pantry

Client Status of OPEN CUPBOARD

Current New

Date (Pick up or delivery date) *

Date

Preferred Pick Up Time

Tuesday AM Tuesday PM Wednesday AM Thursday AM Friday PM

Full Name

First Name Last Name

Contact Number *

Area Code Phone Number

E-mail *

# Adults (18 + older)

# Seniors (65 + older)

# Children (under 18)

School Lunch Program?

Yes No

How many children are eligible?

Transportation

PICK UP Delivery - INCLUDE ADDRESS (MUST have approval from Main Office) LINK Other

Delivery Address

Please choose the item (s) you would like - UP TO THE TOTAL AMOUNT ALLOWED for your family size.

GRAINS - 1-2 Family Size = 3 choices
3-4 Family Size = 5 choices
5+ Family Size = 6 choices

GRAINS

SOUP - 1-2 Family Size = 3 choices
3-4 Family Size = 5 choices
5+ Family Size = 6 choices

SOUP

MISCELLANEOUS - 1-2 Family Size = 1 choice
4+ Family Size = 2 choices

MISC

VEGETABLES - 1-2 Family Size = 5 choices
3-4 Family Size = 7 choices
5+ Family Size = 8 choices

VEGETABLES

FRUIT- 1-2 Family Size = 2 choices
3-4 Family Size = 3 choices
5+ Family Size = 4 choices

FRUIT

PROTEIN - 1-2 Family Size = 2 choices
3-4 Family Size = 3 choices
5+ Family Size = 4 choices

PROTEIN

NON-FOOD - 1-2 Family Size = 1 choice
3+ Family Size = 2 choices

NON-FOOD

OCFP - Open Cupboard Pantry Clients ONLY

USDA - United States Department of Agriculture

TANF - Temporary Assistnace to Needy Families (Must have children under 18 years old)

SFPP - State Food Purchase Program

Dairy (Choose ONE cheese variety)

OCFP

USDA

SFPP

Milk

Eggs

American Cheese

Cheddar Cheese

Cream Cheese

Shelf MIlk

Produce (based on availability)

YES NO

Baked Goods (based on availability)

YES NO

Meat & Meat Alternatives

OCFP

USDA

SFPP

Pork

Venison

Beef

Chicken

Meatless /Plant Based

Fish

ADDITIONAL PICKS

Use this field to request specialty items such as diapers, pet food, laundry etc.

Special Instructions

Pick up Option *

In house appointment requested No contact pick up

My appointment is currently scheduled for: (date/time)

Volunteer to WEIGH all bags and list HERE.

Volunteer to WEIGH all bags and list HERE.