Partner Agency - Monthly Report 2020

Agency Information

Agency Name & Number *

Begin Typing then select your Agency Name

Type of Feeding Program *

On-Site Pantry

Report for (month/year)

Month *

Year *

Onsite

Pantry Feeding Program

Pantry Reporting - Household served

How many total days did you distribute this month?

This would be the number of days that you were actually open to the public and served clients. Please do not count any one off days (Ex: you served a walk in or served a shut in)

How many individual households served this month? (Unduplicated)

Based on intake forms. Only count the household once. Number of households served (Families

How many total households served this month?

Based on sign in sheets. Count all the visits, including repeat households served

How many new households served this month? (Duplicated)

First time households to your pantry

Total number of MEALS served during the month
(not including supplemental snacks)

Breakfast

Lunch

Dinner

Total number of supplemental SNACKS served during the month

Snacks

How many total clients, by age group, did you serve this month? (only count per individual Household based on #2 or served)

Children (17 & under) *

Adults (18-59) *

Seniors (60+) *

Additional information

What percentage of the food you use comes from NTFB *

Person Preparing This Report

Name *

First Name Last Name

Title *

E-mail *

Name

First Name Last Name

Phone Number

Area Code Phone Number