Partner Interest & Pre-Qualifier Form

Agency Partnership: Interest & Pre-Qualifier Form
Thank you for your interest in partnering with Second Harvest Foodbank of Southern Wisconsin (SHFB). Our partner agencies are essential to the work in achieving our vision that everyone in our community has enough nutritious food to thrive. SHFB works with partners to provide support for the 1 in 10 folks who are facing hunger in southwestern Wisconsin - more than 100 million meals since 1986. We currently work with over 200 agency partners across our 16-county service area.

What is a food bank and why partner with Second Harvest?

Second Harvest exists to end hunger in southwestern Wisconsin. As a food bank, we work to support our agency partners in the community by distributing food to food pantries, meal sites, partners that provide temporary or transitional housing, in-school and after-school programs, and other programs that are addressing food insecurity and its root causes. As a food bank, we are a food sourcing clearinghouse, a sorting center, a repackaging site, and a distribution hub leveraging our resources and infrastructure to connect donated and purchased food to our partners. Any food that we receive at no cost is shared with our partners at no cost. We also source in-demand food items at wholesale prices and share that savings with partners - or at lower costs (sometimes at no cost).
- We work together with hundreds of local organizations that are working to end hunger across our 16 counties to remove barriers and provide access to resources in the community.
- We are dedicated to providing healthy and nutritious food to partner agencies and programs.
- We are a member of Feeding America , a nationwide network of member food banks and the nation's largest domestic organization working to end hunger.
Important considerations:

Second Harvest will utilize your completed form to determine whether your organization may be eligible for partnership. We cannot guarantee partnership based on this information only, nor does meeting qualifications guarantee partnership. Second Harvest Foodbank reserves the right to limit the number of partner agencies within a geographic or programmatic area.

Second Harvest prioritizes programs that are filling unmet gaps in addressing food insecurity throughout our service area. Please note that it is also important to consider locations of other food programs in your area. We encourage partnerships with agencies that are already distributing food in your community. It may be more effective for you to provide volunteer or financial support to help them expand their hours or the number of people they support rather than starting a new program.

For additional questions, contact Second Harvest Foodbank of Southern Wisconsin Partnerships and Programs at 608-216-7247 or pilare@shfbmadison.org.

FORM INSTRUCTIONS:

Please include as much detail as possible when answering questions on the following pages. This information will be used to determine whether you are eligible to be a partner agency, as well as whether your program aligns with the current plans and strategy of Second Harvest Foodbank. If eligible and aligned, further application materials will be shared with you.

Note: If you have multiple food programs you would like to apply for, please fill out a separate form for each.

Section 1: Non-profit Status
Organizations interested in Partnership must meet the following minimum criteria:
1. Have and maintain 501c3 status with the Internal Revenue Service or meet the criteria of a religious organization as defined by the IRS and " donated property must be used solely for the care of the ill, the needy, or infants, and in a manner related to the donee's exempt purpose. IRC 170(e)(3)" . Evidence of status must be provided to SHFB. The Agency cannot be a private foundation or a municipality. 501c3 is not the same as state sales tax exemption. Mosques, synagogues, churches and other religious organizations generally meet this qualification as a religious organization. If you have questions about your tax-exempt status contact the IRS Tax Exempt and Government Entities Customer Account Services at 877.829.5500.
2. Will have an active Board of Directors and will strive to abide by the standards for governance stated in Principles and Practices for NonProfit Excellence from the WI Council of Non-Profits.
Name of Organization *
Mailing Address of Organization *

Street Address

Street Address Line 2

City County

Postal / Zip Code
Is the site address (where you will be distributing food) the same as the mailing address of the organization? *

Yes No
Site Address (where you will be distributing food) *

Street Address

Street Address Line 2

City County

Zip Code
Primary Contact Name *

First Name Last Name
Primary Contact Email *
example@example.com
Primary Contact Phone *
Please enter a valid phone number.
Organization Website/Facebook:
What type of tax-exempt status does your organization have? *

We are a registered 501(c)(3) We are a faith-based organization that meets the IRS standards We are in the application process for a 501(c)(3) We do not have tax-exempt status but have a Fiscal Sponsor that does None of the above
Does your food program have a current and active Board of Directors or advisory council? *

Yes No
How many members are on your board of directors and how often do they meet? (Please answer both questions) *

Section 3: Compliance
Organizations interested in Partnership must meet the following minimum criteria:
1. In the interest of keeping guests healthy and safe, agencies must maintain adequate cold and dry storage space to ensure the integrity of the food/product until it is used and/or distributed . Food storage and service cannot be located in a staff/volunteer’s personal residence. No SHFB product can be stored off-site, or distributed to unapproved programs or sites. Unapproved programs/sites include: outside of the approved indoor storage area, non-partner agencies, personal residences, common areas of apartment buildings, or any unmonitored/self-service pantry or cupboard program.
2. Will have at least one staff or volunteer complete Food Safety training approved by SHFBSW and will share best practices on Food Safety with other staff and volunteers. Food safety requirements vary by type of program and tools and resources will be provided by the Agency Services team to assist with this compliance measure for Agency Partners.
What types of storage does your food program have? (check all that apply) *

Dry storage Designated Coolers Designated Freezers We do not have any storage spaces Other
Do you maintain professional pest control at your storage site? If so, how often? *
Do you have adequate racking in your storage spaces that allows all food products to be at least 6 inches off of the ground? *
Are your storage spaces secured to avoid tampering? *

Yes No Other

Section 4: Program Recipient Information
Organizations interested in Partnership must meet the following criteria:
1. A majority of the program’s beneficiaries are people experiencing food insecurity.
2. Will not deny access to food/product on the basis of any discriminatory practices (including on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistant program, or protected genetic information, in employment, or in any program or activity conducted or funded by the USDA).
3. Must not distribute food/products in exchange for money , property or services. Must provide food at no cost, nor request any financial donation from guest. Partner Agency/Program cannot exchange SHFB products for money, other property or services, nor require participation in prayer or religious or other services, including volunteer service. (i.e. guest cannot be charged a fee or asked for a donation for the food, food cannot be sold as a fundraiser, etc.)
Are the majority of your guests low income, ill, or children? *

Yes No
Are donations or fees requested, encouraged, or accepted from participants during food distribution/meals? *
Eligibility requirements for service at your Food Program: *
Describe how you track guest information and keep it confidential and secure: *
Number of guests served monthly in your Food Program: *
How many times per month will guests be allowed to access food? *
Geographic area that you support with your Food Program: *
How will you ensure your staff and volunteers treat your guests with respect and avoid judgmental comments? *
Describe how your guests will receive food i.e., choose from a list, pick from shelves, etc *
How is your work supporting an area/population that is not currently supported by other hunger relief programs in your area? *
As a reminder, this form is NOT an official partner application or a guarantee of partnership with Second Harvest Foodbank of Southern Wisconsin.

Partner Agency Interest Forms are reviewed on an ongoing basis by the Agency Services team. We will be in touch with your listed primary contact in the next few weeks.

If you have any questions or concerns, please contact Second Harvest Foodbank of Southern Wisconsin Agency Relations at pilare@shfbmadison.org.
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Agency Partnership: Interest & Pre-Qualifier Form

Section 1: Non-profit Status

Section 2: Food Program Details and Capacity

Section 3: Compliance

Section 4: Program Recipient Information