Enrollment Information Form

Program Enrollment Information

Fletcher Place Community Center and Southeast Community Services have joined forces to create a new and improved pantry experience! Going forward the pantry will use a monthly pick-up system, neighbors will be asked to pick up their food only once a month. To help us individualize what neighbors are receiving each month and keep our inventory stocked with individual preferences we are asking for some family information!
*Enrollment Form only needs to be completed once*

If you have already completed this form, please move on to the

Pantry Preference Form found here.
Name *

First Name Last Name
Home Address *

Street Address

Apt / Unit Number

City State

Zip Code
Which of the following programs would you like to enroll in? *

Food Pantry Thrift Store Both
Have you been to either Fletcher Place Community Center or Southeast Community Services before? *

FPCC SECS Both Neither

Program Enrollment Information