English: Trinity Jubilee Center Food Pantry Signup 2025-2026

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Welcome! Thank you for filling out your Food Pantry intake form online!
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What is your name?* This field is required.
First Name
Last Name
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What is your email address?* This field is required.We will send you a link to reopen your form in case you need to correct any info later.
example@example.com
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What is your birthdate?* This field is required.
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What is your race?Please choose one
White
Black or African American
Asian
American Indian/Alaska Native
Native Hawaiian / Other Pacific Islander
American Indian / Alaskan Native & White
Asian and White
Black / African American & White
American Indian / Alaskan Native & Black / African American
Other
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What is your ethnicity?* This field is required.Choose one:
Hispanic
Non-Hispanic
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What is your sex?* This field is required.
Female
Male
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How many total people are in your household, including yourself?* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
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Person #2 Name and Birthdate
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Person #3 Name and Birthdate
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Person #4 Name and Birthdate
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Person #5 Name and Birthdate
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Person #6 Name and Birthdate
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Person #7 Name and Birthdate
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Person #8 Name and Birthdate
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Person #9 Name and Birthdate
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Person #10 Name and Birthdate
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What is the address where you live? Please include your town and your apartment number!* This field is required.
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Ok
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Is anyone in your household a US military veteran or active-duty serviceman?* This field is required.
Yes
No
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Thank you for your service! What is their name?
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Have we recently helped you connect with another organization?Such as General Assistance, a senator’s office, a case manager, an outreach worker, etc.
YESNO
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Does someone in your household work?* This field is required.
Yes
No
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If not, why not?
Retired
Disability or illness
No work permit
Currently applying for jobs
Not working
Other
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Other:
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Do you have transportation to the grocery store?* This field is required.
Yes
No
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Think about all of the fresh fruits and vegetables you ate over the past month. Did the majority of them come from Trinity's food pantry?* This field is required.
Yes
No
N/A New to the food pantry
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Do you come to our 11:00 Soup Kitchen to receive meals or other food?* This field is required.
YESNO
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How many days per week do you come to the Soup Kitchen?
Please Select
Please Select
1
2
3
4
5
6
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Do you eat healthier because of the Soup Kitchen?
Yes
No
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Is this your primary source of hot meals?
Yes
No
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Client Information Tracking Sheet: Lewiston-Auburn Metropolitan Statistical Area The City of Lewiston has been awarded Community Development Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development. The proposed activity/ies are for the Trinity Jubilee Center. For the proposed activity/ties, the CDBG program requires documentation of program benefit. Therefore, the Trinity Jubilee Center is surveying the potential beneficiaries ensuring compliance with CDBG program regulations. Your response to the following questions is critical for meeting CDBG program requirements. All responses are confidential and used solely for securing CDBG grant funds. THIS INFORMATION WILL BE KEPT CONFIDENTIAL.
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Based on the previous "Client Information Tracking Sheet: Lewiston-Auburn Metropolitan Statistical Area" chart, please select your income limit:* This field is required.
Extremely low
Low
Moderate
Over 80% MFI
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Do you live in Lewiston?* This field is required.
Yes
No
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I certify that all information provided is accurate.* This field is required.Signature:
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Date* This field is required.
Date
Year
Month
Day
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Image Field
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New this year is the requirement that funds are utilized in accordance with immigration restrictions and requirements including eligibility and verification. CDBG funds and other federal funds such as HOME cannot be utilized to provide benefits for those who are not in the US legally. Therefore, each applicant will have to provide proof of legal presence in the U.S. for services. Please upload one of the following:* This field is required.Social Security Card Unexpired U.S. Passport Unexpired Maine Real ID Unexpired Real ID Compliant Driver’s License U.S. Birth Certificate Certificate of Naturalization Certificate of Citizenship United State Customs and Immigration Services (USCIS) documentation Document from a federally recognized Indian tribe (A tribal enrollment card, A Certificate of Degree of Indian Blood, A Tribal census document, Document on Tribal letterhead signed by an Official) State of Maine Identification card with photo Medicare Card Supplemental Social Security (SSI) Social Security Retirement Social Security Disability Insurance (SSDI) Medicaid Card SNAP (Supplemental Nutrition Assistance Program) TANF (Temporary Assistance for Needy Families) Proof of Receipt of Municipality General Assistance Proof of other State or Federal government benefit requiring the same verification as above
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Max. file size: 10.6MB
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I verify that the following documentation has been provided:* This field is required.
Social Security Card
Unexpired U.S. Passport
Unexpired Maine Real ID
Unexpired Real ID Compliant Driver’s License
U.S. Birth Certificate
Certificate of Naturalization
Certificate of Citizenship
United State Customs and Immigration Services (USCIS) documentation
Document from a federally recognized Indian tribe (A tribal enrollment card, A Certificate of Degree of Indian Blood, A Tribal census document, Document on Tribal letterhead signed by an Official)
State of Maine Identification card with photo
Medicare Card
Supplemental Social Security (SSI)
Social Security Retirement
Social Security Disability Insurance (SSDI)
Medicaid Card
SNAP (Supplemental Nutrition Assistance Program)
TANF (Temporary Assistance for Needy Families)
Proof of Receipt of Municipality General Assistance
Proof of other State or Federal government benefit requiring the same verification as above
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I certify that all information provided is accurate.* This field is required.
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Please upload proof of your address. This can be a bill, a lease, a DHHS statement, or other official mail. It must be less than 2 months old.* This field is required.If you do not have it available right now you can upload it later. Your application will be incomplete until this proof is received.
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Max. file size: 10.6MB
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If you would like to enroll in our Diaper Bank, please upload proof of your child's name and birthdate. This can be a birth certificate, Mainecare card, passport, or other official document. We provide diapers to children under 48 months.If you do not have it available right now you can upload it later. You must provide this proof before receiving diapers.
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Max. file size: 10.6MB
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Signature:* This field is required.By my signature below, I release the Trinity Jubilee Center and the original donor from any liability or harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and covenant not to sue the released parties with respect to such harm or losses. I understand that the Trinity Jubilee Center operates on limited funds and in support of others, and I will only request and take items that I reasonably expect myself and/or my family to use. My household will not receive food from the Trinity Jubilee Center’s food pantry more than once per week.
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Do you have feedback for us?We know the Food Pantry is busy and there's not a lot of time to talk! We would love to hear from you! What could we do to make the Food Pantry better?
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