The Emergency Food Assistance Program (TEFAP) Household Eligibility Criteria Form
Do you certify that your gross household income is at or below the amount listed in the chart for your household size?
*
YES
NO
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I certify that my gross household income is at or below the income listed in the above chart for the number of people in my household.
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Where do you live?
Attleboro – 02703
Mansfield – 02048
North Attleboro – 02760
Norton – 02766
Plainville – 02762
Rehoboth – 02769
Seekonk – 02771
None of the Above
If You Live Outside Our Service Area
:
You will receive a pre-packed emergency bag of USDA-approved foods.
We will also help connect you with food pantries closer to your residence.
Submit & Call Our Office
Submit & Continue to Shopper Intake Form
Should be Empty: