Agency Name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address of Food Distribution
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Middle Name
Last Name
Title
*
Contact Phone
*
Contact Email
*
example@example.com
What is your agency's mission?
*
Agency Website and/or Social Media Pages
*
Employer Identification Number (EIN)
Current Food Distribution Details
Type of Food Distribution
*
Pantry (provides groceries to the general public)
Soup kitchen or congregate meal site (provides prepared meals cooked on-site to the general public)
Other (please specify below)
How many staff member(s) and/or volunteer(s) are currently assisting with the distribution?
*
Rows
# of Individuals
Staff
Volunteers
How many staff member(s) and/or volunteer(s) have a current Food Handlers/Manager certification?
*
Rows
# of Individuals with Food Handlers Certification
# of Individuals with Food Manager Certification
Staff
Volunteers
How long has your organization's food distribution program been in operation?
*
How many times a month do you hold a food distribution?
*
One
Two
Four
Other (please specify below)
Enter the days and times you're currently distributing food each month.
*
How many times can one client utilize your program during a month?
*
Once per month
Once per week
As many times as needed
Other (please specify below)
Are you open to the public?
*
Yes
No
How many households do you currently serve on average per distribution?
*
What demographic groups are represented among your clients? Please list all that apply (i.e. unhoused individuals, seniors, veterans, African Americans, Asians, etc.).
*
What are your client eligibility requirements (if any)?
*
What proof (if any) do you require to verify client eligibility?
*
Do you require clients to pay (including optional donations), pray (including optional prayer) or work to receive food?
*
Yes
No
What food items do you currently have available for distribution?
*
Canned produce
Fresh produce
Bread
Dairy
Meat
Non-meat proteins
Beverages
Other (please specify below)
What's your current source(s) of food for your distribution?
*
Food drives
Local community gardens or farms
Purchases from wholesale outlets or local grocery stores
Other (please specify below)
Has your agency secured funding to sustain your distribution long term (i.e. rent, utilities, supplies, transportation, etc.)?
*
Yes
No
What is your monthly food program budget?
*
How do clients find out about your food distribution?
*
Word of mouth
Agency outreach materials
Referrals
Social media
Other (please specify below)
Does your agency currently have access to a computer and internet?
*
Yes
No
Food Storage, Safety and Transportation
How many square feet do you have for your dry food storage?
*
None
Small closet with shelving (< 6' x 10')
Small room with shelving (between 6' x 10' and 15' x 15')
Storage room for up to 10 pallets
Storage room for more than 20 pallets
Small warehouse with racks for pallets
Other (please specify below)
How many of each type of refrigerator do you have?
*
Rows
# of Units
Residential Refrigerators
Commercial Refrigerators
Chest Refrigerators
Walk-in Refrigerators
How many of each type of freezer do you have?
*
Rows
# of Units
Residential Freezers
Commercial Freezers
Chest Freezers
Walk-in Freezers
What type(s) of vehicles does your organization have to transport food to your agency site?
*
Grocery Recovery
Grocery recovery or store donation programs are when grocery retailers agree to set aside edible food they can no longer sell for a food recovery organization to pick up. SFBFS' grocery recovery program, called Grocers Feed the Hungry (GFTH), creates direct relationships between our partner agencies and stores.
Would you be interested in participating in Grocers Feed the Hungry?
*
Yes
No
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