Aloha In Action: Yano Hall
Eligible participants include: SNAP recipients and Federal Workers
By completing this form, you attest that you are signing up for the following:
I am registering to pick up food supplies from the YANO HALL site, located at 82-6145 MAMALAHOA HWY, CAPTAIN COOK, HI, 96704 whose pick up days are THURSDAYS from 2:00 PM to 5:30 PM during the first 3 weeks of November. (Nov. 6, Nov. 13, Nov. 20)
I am signing up for the following site as listed above.
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Yes, I understand
By completing this form, you attest that you have read and understand the following:
I am a current SNAP recipient and/or Federal employee and can provide verification documents.
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I agree
I understand supplies are extremely limited and only 1 member of my household is registering for this program.
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I agree
I agree to receive text reminders for the duration of the program.
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I agree
I understand and agree that food will only be distributed with a valid ID at pick-up.
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I agree
Space is limited and filled on a first come, first served basis, using the timestamp of when my registration was submitted.
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I agree
If any field on this application is missing information, my registration "timestamp" will be updated to the day and time it is accurate and complete.
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I agree
Once I am confirmed for a pick up location, I will not change pick up location at any time during the program.
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I agree
If I do not pick up my food by the end of the pick up time, it will be given to another household on the waitlist.
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I agree
If I miss any pick up days, my name will be removed and put on the waitlist.
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I agree
Recipient Information
What qualifying documentation can you provide to confirm your eligibility for this program?
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Please Select
Hawai'i EBT Card (with matching name)
DHS Approval or Renewal Letter for SNAP/EBT
Federal Employee ID Badge (PIV/CAC)
Recent Federal Pay Stub
Official Furlough/Shutdown Notice Email
Upload your document (PDF or JPEG file). NOTE: The uploaded document must show your full name that matches this registration form. If your EBT card has no name, please include your DHS Approval/Renewal Letter.
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Recipient Name
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First Name
Last Name
Recipient Cell Phone. NOTE: All communication will be sent via text. Please be sure the number entered is correct.
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Please enter a valid phone number.
Recipient Email
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example@example.com
Physical Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to volunteer (help pack, distribute, etc.) at the site you are picking up from?
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Yes
No
Secondary Pick Up Person
You can name (1) other adult to pick up the food on behalf of your household. This is the only other person who can pick up meals for the duration of the program. Once the application is submitted, this person cannot be changed.
Secondary Pick Up Person: Name
First Name
Last Name
Secondary Pick Up Person: Cell Phone
Please enter a valid phone number.
I attest that the information above is accurate.
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Submit
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