Food Hamper Application

Food Hamper Application

The following form will start the process for an application for a food hamper or other services.
Consent. By completing this form you are giving voluntary and implied consent to disclose information for use in your application.

Alternative ways to apply. If you do not want to disclose information via an on-line form, then please call the Centre for Newcomers to make an in-person appointment for your application at 403-569-3325.

Required Information. Only your name and contact information are required to start your application using this form. All other information is optional. However, once you are assigned to a Case Manager, then you will be required to provide the following information to the Case Manager to complete the application.

Voluntary participation. Completing any information using this form is completely voluntary and incompletion of any data will not hinder the process and review of your application by a Case Manager. Completing the application here will simply make the application process faster.

Submitting information and return reply. When you click on "Submit Form" it will be directed to a Manager at the Centre for Newcomers. The Manger will assign you to a Case Manager to process your application and complete any information that you do not disclose here.

A Case Manager will contact you after you submit your name and contact information.
SECTION A. The following information helps us contact you, gives us information about who in your household needs a food hamper, and helps us arrange the best possible hamper for you.
Applicant Name (required)*

First NameLast Name
Applicant's Home Address (required, especially for food delivery options)*

Street Address

Street Address Line 2

City/Town

Postal Code
A Phone Number or Email address is Required to contact you.
Applicant's Phone Number (we may need to call you about your food needs)

Area CodePhone Number
Applicant's E-mail (required if you wish to have a copy of this application; it will be sent to this email)
If you are a worker, helping a client, then please complete the following contact information.
Referring Work's name (complete only if you are applying for an applicant or helping them to complete the form)

First NameLast Name
Referring worker's email (complete only if you are applying for an applicant or helping them to complete the form)
example@example.com
Referring worker's phone number (complete only if you are applying for an applicant or helping them to complete the form)

Area CodePhone Number
Referring Organization Name (complete only if you are applying for an applicant or helping them to complete the form)
In addition to the applicant, who else is in the home and requires food?
What is your partner/spouse status (this helps us create a hamper for you)?
If you have children or others in your home, then how many require support and are dependent on you for food (knowing this helps us create a hamper for you)?
SECTION B. The following information helps us arrange the best possible food hamper for you.
I require access to the Calgary Food BankI require food immediately, it is an emergency
I require Filipino foodsI require Ethiopian/Eritrean foodsI require Vietnamese foodsI require Chinese foodsI require South Asian foodsOther
I need a food hamper with special dietary needs (if so, please note the food requirements below)I need a food hamper for diabeticsI need an halal food hamperI need a kosher food hamperI need a vegetarian food hamperI am a veganOther
Is there any specific food that you require? Please describe this.
RiceLoaves of BreadRye BreadPita WrapsKidney BeansChick Peas ,CannedOrange LentilsSpaghetti NoodlesMac Cheese, boxChicken Noodle SoupMr NoodlesWhite OnionsCarrot, freshCucumber, freshCabbage, freshBananasApplesTea bagsCoffee instantCerealSaltCooking Oil
DisinfectantAlcoholHand sanitizerFace masksToilet paperDish washing soapFeminine hygiene productsToothpasteShampooOther
How can food get to you?
SECTION C. The following information helps us to open a file for you and will help us arrange additional services if you require or request them. If you do not wish to complete this section, then proceed to "Submit Form."
Date of Birth

MonthDayYear
Date
Gender
If other gender, please let us know what you prefer to be referred to.
What is your Immigration Status?
What is your UCI/ID or Immigration Number?
If you do not have one leave this blank
When did you arrive to Canada?

MonthDayYear
Date
When did you arrive to Alberta?

MonthDayYear
Date
What was your last Province of Residence in Canada before living in Alberta?
What is your 1st Language?
What Language do you want services in?
Retype if you need service in another language or translation services
What is your highest Education level?
What is your employment status?

Let us know your income sources (If you are receiving no income or benefits, then leave this table blank)?

Rows	I have this	I have applied for this	I need help to apply for this	N/A
Employment Insurance
Income Support
AISH
Fair Entry
Canada Child Benefit and Child Tax Benefit
GST Rebate
Climate Change Rebate
Canada Emergency Relief Benefit
Student Emergency Benefit
Working Full-Time
Working Part-Time

Do you also need financial support in the form of a microloan or grant?
Help applying for Canadian Citizenship or permanent residencyHelp applying for refugee statusHelp finding evidence for my refugee claimHelp learning EnglishHelp finding a translatorHelp applying for a job or starting my career in CanadaHelp applying for school, college, or universityHelp connecting with new peopleHelp finding a safe community or belongingHelp with feeling safeHelp finding a lawyer, doctor, or other professionalHelp applying for Fair Entry (reduced rates for transit passes and other city services)Help finding a counsellor or someone to talk to
What other topics or services would you like to know more about?
Type whatever services or assistance you require.
How did you learn about our services?
I understand when I click "Submit Form" that I am giving my information voluntarily and that I am not obliged to give any of the information above. It will only be used to assist with my settlement services and advice at the Centre for Newcomer, and the effectiveness of the services that are provided. If I have a file with Immigration, Refugee and Citizenship Canada (IRCC), or with Alberta Human Services (AHS), then the information can be used and shared with IRCC or AHS to help me obtain services. If I do not have a file with IRCC or AHS, then this information will not be shared with them. None of the information above will be used to make decisions about me personally.

The personal information you have provided herein is collected in accordance with Section 32 of the Freedom of Information and Protection of Privacy Act. I understand that I have the right to view my personal records at any time. I also understand that I have the right to correct any information or delete my information when I request this from the Centre for Newcomers. I also understand that I can withdraw my consent for services from the Centre for Newcomers at any time.
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