BCS Agency Application

BCS Agency Application
Your Organization*
Yes
https://www.birchcommunityservices.org/agency-guideline/

https://www.birchcommunityservices.org/about/
YesNo
Please upload your 501c3 Letter of Determination.*

Cancelof
Your Name*

First NameLast Name
Your Title*
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Agency Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How are you funded?*
What other sources do you have for assistance (food, etc)?:*
How often do you receive other assistance?: *
Why do you desire the assistance of Birch Community Services?:*
What is your primary target group?:*
How often do you provide food/goods to your target group?:*
What are the days and times you distribute?*
Approximately how many people do you feed in that timeframe?:*
Where do you distribute and what does the facility provide? Do you store and serve at the same location?*
What food safety practices do you have in place?*
What is the date you have or will begin to distribute in this manner?*
How do you advertise or spread the word to your target group?*
I have additional questions about:*
I understand that nothing I receive from BCS may be sold or traded. *
Yes
Signature

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