CSL Family Food Connection Food Pantry
Please complete this form to sign up for food assistance. Limit to ONE sign-up slot per household and TWO sign-ups per month. If you miss your appointment, you will be asked to sign up for a new appointment. This is a drive-up food pantry. CSL is an equal opportunity provider. Review the "Application for Receipt of USDA Food - FD-15A-Part 1" document below before signing up. Sign-ups are open up to 21 days in advance. Please save your confirmation email and look for a reminder email before your appointment.
Do you receive Public Assistance (PA) or Non Public Assistance (NPA)?
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PA
NPA
Zip Code
Postal / Zip Code
County
Name
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First Name
Last Name
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
How old are you?
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Enter current age.
What is your gender?
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Please Select
Male
Female
Transgender
None of these
What is your race?
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Please Select
White
Hispanic/Latino/Spanish
Black/African American
Asian
American Indian/Alaska Native
Middle Eastern/North African
Native Hawaiian/Other Pacific Islander
Other race or Ethnicity
Don’t know
Prefer not to answer
How many children (18 and younger) are in your household? Please fill in 0 if not applicable.
*
How many adults (18-65 years old) are in your household? Please fill in 0 if not applicable.
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How many senior adults (65 and older) are in your household? Please fill in 0 if not applicable.
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Appointment Day/Time
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By signing up, you agree to the terms and conditions as outlined in the "Application for Receipt of USDA Foods - FD -15A-PART 1."
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AGREE
Submit
Should be Empty: