2025-26 TEFAP (Food Bank) Application & Registration
Please read the notice below. Effective October 1, 2025 - September 30, 2026
In accordance with federal civil rights law and USDA civil rights regulations and policies, the USDA, its agencies, offices, employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.), should contact the state or local agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in. the letter all of information requested in the form. To request a copy of the complaint form, call (866)632-9992. Submit your completed form or letter to USDA by:
Mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410; or Fax: (202) 690-7442; or Email:program.intake@usda.gov
Total people in household?
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Name of the person in your household most often picking up the food (your enrollment will be under that person's name):
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PO Box:
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Physical Address:
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City, State, Zip:
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Phone Number:
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Program Benefits: If you currently participate in a program listed below, you are automatically eligible to receive TEFAP. Do you receive benefits from any of the following programs:
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SNAP (Food Stamps)
Tribal TANF/ATAP
SSI or MEDICAID
NSLP LUNCH FREE/REDUCED
CSFP or FDPIR
None of the Above
Did anyone in your household receive the current year's PFD?
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Yes (Please include the total household PFD amount in your household income estimate below.)
No
Estimated household annual income (include PFD):
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Were you evacuated from your home due to Typhoon Halong?
Yes
No
Are you a host family for people who were evacuated from their homes due to Typhoon Halong?
Yes
No
Do you authorize a TEFAP Proxy or Authorized Person(s) -- someone who can pick up your boxes for you -- in the event that you cannot sign for the receipt of a monthly TEFAP box?
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Yes
No
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TEFAP Proxy or Authorized Persons:
In the event I cannot sign for receipt of a monthly TEFAP box, I hereby give permission to the following individual(s) below to sign for receipt of a monthly TEFAP box on my behalf. My approved Alternate(s):
Full Name:
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Relationship:
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Address/Apt. # if applicable:
Phone:
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(Person 2) Full Name:
(Person 2) Relationship:
(Person 2) Address/Apt. # if applicable:
(Person 2) Phone:
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Self-Certification
This institution is an equal opportunity provider.
Please check the box to indicate that you agree with the statement below.
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I certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge and that I am eligible to receive USDA Foods according to current income guidelines.
Submit
Should be Empty: