AmPowering's Feed The Need Program
AmPowering (www.ampowering.org)
We are a 501(c)(3) non-profit agency, AmPowering (EIN #82-1392485 ), dedicated to reaching out to communities in need of food and other assistance through our FeedTheNeed program. Despite the existence of many food banks, there are still significant gaps in food assistance that leave many individuals and families struggling. Our goal is to fill these gaps and ensure that no one goes hungry. If you are in need of these resources, please submit the form to receive assistance.
I want assistance
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Grocery
Household cleaning supplies
Personal hygiene items
Diapers
Rental assistance
Other
Gender
*
Male
Female
Transgender
Don't Prefer to answer
Your Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of birth
*
-
Month
-
Day
Year
Date of birth
Number of people in the family
*
Number of people in each age category:
Age 0-17
Age 18-24
Age 25- 34
Age 35-44
Age 45-54
Age 55-64
Age 65-74
Age 65-74
Ethnicity
*
White
Asian
American Indian
Black of African American
Middle Eastern or North African
Hispanic Latino or Spanish Origin
Native Hawaiian or Other Pacific Islander
Other
Education
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Less than HS Diploma
High School
Some College
Bachelors Degree
Graduate Degree
Higher Education
Employment
*
Student
Unemployed
Self-employed
Part-time employment
Full-time employment
Household Income
*
$0 - $24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 and above
Marital Status
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Single
Married
Divorced
Widowed
Languages spoken
*
Do you have any disability
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Yes
No
Type of disability
Submit
Should be Empty: