Monthly Report
TEFAP Agencies (Onsite Pantry, Onsite Feeding)
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Agency ID#
*
Agency Name
*
Email
*
example@example.com
Person Completing the Report
*
First Name
Last Name
What Month are You Reporting For?
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Did you conduct a Distribution During this Month?
*
Yes
No
Total Households Served
*
If your agency serves TANF, enter the number of families with children served. If none, enter 0
*
Total Individuals Served
*
# of Children 18 and Under
*
# of Adults 19-59
*
# of Seniors 60 and Over
*
# of Veterans
*
Please verify that you are human
*
Submit
Should be Empty: