April 2022 Food Distribution Request Form

April & May Weekly Food Box Distribution: FREE Trader Joe's, Safeway, Panera & Midwest Food Bank Food Box. Thursdays from 1 pm - 3 pm in Mesa and 4 pm - 5 pm in Coolidge**

Please select your food box pick up date and time and note that multiple dates can be selected.
Food Distribution for Families Impacted by Foster Care Presented by ASA Now.

Note: Registration closes at noon the day before distribution. If you are in need of a food box and miss the registration deadline, please call 623-428-1592 for assistance.

Caring for children impacted by foster care on a daily basis can be very stressful and difficult for foster and adoptive parents. This ultimately takes a toll on the family as a whole. ASA Now cares and understands and wishes to gift all families impacted by foster care with a food box to help offset the cost of your grocery bill.

Event Date & Time:

Thursday April 7th, 14th, 21st, 28th, May 5th, 12th, 19th, and 26th.

From 1 pm to 3 pm in Mesa and 4pm to 5 pm in Coolidge.

Location:

Mesa location pickup (1 pm - 3 pm): Jacob's Mission Community Center - 7830 E. University Dr. Mesa, AZ 85207. We are located on University between Sossaman Rd. and 80th St. on the north side of the street. Parking lot entrance is immediately east of the fire station and our building is set back off of the road. Please drive around the back of the building to the door on the west side of the building and your food box will be placed in your trunk by our angel volunteers.

Coolidge location pickup (4 pm - 5 pm): The Closet - 670 W. Pima Ave.Coolidge, AZ 85128.

**COOLIDGE FAMILIES: We are in need of a volunteer or volunteers to pick up food boxes for the Coolidge area families. In the spring, we averaged 10 families in Coolidge signing up and we were barely able to squeeze the boxes into a minivan. An enclosed trailer or larger van would be ideal. When you register, you can select Coolidge as your pickup location, however unless we are able to find volunteers to transport the food, we will not be able to deliver it to Coolidge. If you are willing to help with this, please call us at 623-428-1592.**

Come prepared with a cooler or cooler bag to put frozen or refrigerated food into. We will not know exactly what we are getting until we pick items up, but we typically receive shelf stable foods, bread, produce, refrigerated, and frozen items.

Cancellations:

We understand that emergencies happen. If you are unable to pick up your food, please send someone in your place and let us know who will be coming.

If you are unable to attend and cannot make arrangements for someone to pick up for you, you MUST notify us ahead of scheduled pick-up time and we ask that you give us as much notice as possible by calling 623-428-1592. Be sure to leave a voicemail or text if we don't answer. Failing to pick up your food box or not notifying us ahead of time will exclude you from future food box events.

Feedback:

Our donors and volunteers love feedback. If ASA Now has blessed your life, please take a minute to leave a positive review on Google and/or on our ASA Now Facebook Page or email us at Hope@asanow.org with your testimonial.

To view our upcoming events please search our events tab on Facebook.

www.asanow.org

With Gratitude,

Angela Teachout

Susan Woodruff

Anika Robinson

'Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has". Margaret Mead
Pick Up Location (select one)

Mesa Coolidge
Click on date(s) you are registering for (click all that apply):

Thursday April 7th
Click on date(s) you are registering for (click all that apply):

Thursday April 14th
Click on date(s) you are registering for (click all that apply):

Thursday April 21st
Click on date(s) you are registering for (click all that apply):

Thursday April 28th
Click on date(s) you are registering for (click all that apply):

Thursday May 5th
Click on date(s) you are registering for (click all that apply):

Thursday May 12th
Click on date(s) you are registering for (click all that apply):

Thursday May 19th
Click on date(s) you are registering for (click all that apply):

Thursday May 26th
Sign Up for One or More Food Distribution Dates to Attend
4-7-22 ASA Now Food Distribution Signup
4-14-22 ASA Now Food Distribution Signup
4-21-22 ASA Now Food Distribution Signup
4-28-22 ASA Now Food Distribution Signup
5-5-22 ASA Now Food Distribution Signup
5-12-22 ASA Now Food Distribution Signup
5-19-22 ASA Now Food Distribution Signup
5-26-22 ASA Now Food Distribution Signup
Caregiver, Parent or Aged Out Youth Name #1 *

Last Name First Name
Caregiver or Parent Name #2 (type N/A if there is not a 2nd caregiver or parent in the home): *

Last Name First Name
Name of Group Home (type N/A if you are not a group home) *
Contact Number (must be a cell phone to receive text reminder) *

Area Code Phone Number
E-mail *
Address *

Street Address

City Postal/Zip Code

COUNTY
Are you: *

Unlicensed Kinship Caregiver Licensed Kinship Caregiver Licensed Foster Caregiver Tribal Foster Caregiver Caregiver with Guardianship to Child with Child Welfare Involvement Caregiver with Guardianship not involving DCS/ Child Welfare Aged Out Youth Licensed Group Home Adoptive Home
Total Number of People Living in the Home *

1 2 3 4 5 6 7 8 9 10
Total Number of Adults Living in the Home (including children over 18 who are no longer in high school) *

1 2 3 4 5 6 7 8 9 10
Total Number of Children Living in the Home (including children over 18 who are still in high school) *

1 2 3 4 5 6 7 8 9 10
Number of Children in Foster Care, Tribal Foster Care, or DCS Guardianship Living in the Home (including those 18 and over who are still in high school): *

0 1 2 3 4 5 6 7 8 9 10
Number of Adopted Children Living in the Home (including children 18 and over who are still in high school): *

0 1 2 3 4 5 6 7 8 9 10
Number of Biological Children Living in the Home (including children 18 and over who are still in high school): *

0 1 2 3 4 5 6 7 8 9 10
Number of NON-DCS Kinship or NON-DCS Guardianship Children Living in the Home (including children 18 and over who are still in high school): *

0 1 2 3 4 5 6 7 8 9 10
I Need Help or Assistance With the Following (Check All That Apply)

Basic Necessities (clothes, underwear, hygiene kits, etc) Emergency Essentials Food Box (Mesa location only) First Aid Kit (Mesa location only) Support Group Training/ Workshops for Caregivers and Youth ages 14-18 Housing for Aged Out Youth K-12th grade Tutoring, Dance, Karate, Art, Cooking, Piano, Guitar, Musical Theater, Yoga (Mesa location only)
As a foster care nonprofit organization, we must obtain certain information from the families we serve. If you are caring for a child or youth with child welfare involvement, we must collect their Notice to Provider information.

If you have been served by ASA Now and you have previously uploaded their Notice to Provider information for any of our events, you may skip the questions below.

If you have never upoloaded their Notice to Provider, this information and/or if they are a new placement in your household, please fill out the form for EACH Eligible DCS Guardianship, Child in Foster Care or Aged Out Youth in order of youngest to oldest.
Have you previously provided information for each child in your home who is: in foster care, tribal foster care, DCS guardianship, or Aged Out Youth? *

Yes, all foster/tribal foster/DCS guardianship/aged out youth in my home have been previously served by ASA Now and I have provided information and uploaded their Notice to Provider (NTP) for a previous event. No, my family has not been served by ASA Now previously so I have not provided information (NTP) for my foster/tribal foster/DCS guardianship/aged out youth No, I have a new placement whose information I need to provide I do not currently have any children who are foster/tribal foster/DCS guardianship/aged out youth in my home. I only have foster/adopted children living in my home.

April & May Weekly Food Box Distribution: FREE Trader Joe's, Safeway, Panera & Midwest Food Bank Food Box. Thursdays from 1 pm - 3 pm in Mesa and 4 pm - 5 pm in Coolidge**

Sign Up for One or More Food Distribution Dates to Attend