Food Shelf Appointment Request Form

Ralph Reeder Food Shelf Appointment Request Form

This is a REQUEST ONLY - A Staff Member Will Reach Out For Confirmation.
The Ralph Reeder Food Shelf is located at 2544 Mounds View Blvd. Mounds View, MN 55112. Fill out the form below and a food shelf team member will reach out to you within 1-2 business days. (Providing this information is optional, if you prefer to not fill out this form, please call the food shelf to schedule an appointment: 651-621-6280).
I have children that attend a school in the Mounds View Public School District (District #621)
Please select
Have you visited our food shelf before?

YesNo
Head of House*

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Apartment Number

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number

Area CodePhone Number
I am in Minnesota and my household income is 300% or less of the Federal Poverty Guidelines according to the following chart:*

YesNo

Income Eligibility (300% of Federal Poverty Guidelines)

For each additional member, add $16,500 of allowable income

I have been shown and have read the USDA Statement and the MN Data Privacy Notice.*

YesNo
If you have additional family members in your household who need food, please record their information below. If not, please click the next button at the bottom of the page.
Your income exceeds our guidelines, however if you are in crisis and need food, please call the food shelf to request an appointment: 651-621-6280.
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date
Family Member

First NameLast Name
Birthdate

MonthDayYear
Date