Halal Food Assistance Program Intake Form

East African Dream Organization

Halal Food Assistance Program Intake Form

2025 Income Eligbility Chart (300% of Federal Proverty Guidlines)

Houshoulds are eligable if their income is at or below the following.

OPTIONAL: Check the program(s) in which you participate:

MFIP – Minnesota Family Investment ProgramGA – General AssistanceSNAP – Supplemental Nutritional Assistance ProgramWIC – Women, Infants, and ChildrenChild Care AssistanceHead StartSection 8Public HousingType option 8Energy Assistance
1-Participant Name

First NameLast Name
2- Family Size Information
Number of Children 0 - 17
Number of Children 0 - 17
Number of Adults 18-64
Number of Adults 18-64
Number of Senior 65 and above
Number of Senior 65 and above
3. Contact Informatio
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4- Goals and Expectations:
5- Additional Notes :
6- Consent
I give East African Dream Organization permission to contact me and assist in applying for

YES
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

2- Family Size Information