Gleaners Partner Agency Inquiry Form

Thank you for expressing interest in partnering with Gleaners Community Food Bank! Gleaners will review all inquiry forms and make determinations based on capacity in the area and available resources. We actively review applications for membership during the months of April through August. Due to the volume of interest, it may take up to 4 weeks to receive a response from us regarding your inquiry form. We cannot guarantee that applicants will be accepted into our food distribution program.

Organization's Name (as it appears on your 501(c)3 letter from the IRS) *

Food Distribution Program Name (if different from what is listed on your IRS letter)

Address (where you plan on storing/distributing food) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Main Contact Name *

First Name Last Name

Main Contact Title *

Main Contact Phone Number *

Please enter a valid phone number.

Main Contact Email *

example@example.com

Secondary Contact Name

First Name Last Name

Secondary Contact Title

Secondary Contact Phone Number

Please enter a valid phone number.

Secondary Contact Email

example@example.com

Link to your website (if applicable)

Link to your Facebook page (if applicable)

Describe your service area (what cities/zip codes do you serve?) *

Type of Program(s) *

Food Pantry Soup Kitchen Shelter Residential Program Other

Distribution Style *

Hot meals Shop in pantry Pre-bagged food Pre-order to allow for client choice Other

Are you able to store food at your location? *

Yes No

How many refrigeration (cooler) units do you have? *

How many freezer units do you have? *

When did your feeding program begin? *

How many households are you serving each month? *

What are your current sources of food? *

What is your monthly budget for food? *

How is your food program funded? *

How many people (staff and volunteers) work in your food distribution program? *

Type of Food Safety certification: *

Food Safety expiration date:

Please provide your food distribution hours of operation (days, times, frequency throughout the month). *

Please explain your food distribution operation. *

Is there anything else you would like to share about your organization?

Upload your IRS Letter verifying your organization's 501(c)3 public charity status as a non-profit.

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Upload any other files -- brochures, flyers, etc. that speak to your organization's work and food distribution efforts.

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