English: Trinity Jubilee Center Food Pantry Signup 2026

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Welcome! Thank you for filling out your Food Pantry intake form online!
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What is your name?* This field is required.
First Name
Last Name
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What is your email address?* This field is required.We will send you a link to reopen your form in case you need to correct any info later.
example@example.com
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What is your birthdate?* This field is required.
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What is your race?Please choose one
White
Black or African American
Asian
American Indian/Alaska Native
Native Hawaiian / Other Pacific Islander
American Indian / Alaskan Native & White
Asian and White
Black / African American & White
American Indian / Alaskan Native & Black / African American
Other
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What is your ethnicity?* This field is required.Choose one:
Hispanic
Non-Hispanic
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What is your sex?* This field is required.
Female
Male
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How many total people are in your household, including yourself?* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
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Person #2 Full Name and Birthdate
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Person #3 Full Name and Birthdate
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Person #4 Full Name and Birthdate
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Person #5 Full Name and Birthdate
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Person #6 Full Name and Birthdate
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Person #7 Full Name and Birthdate
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Person #8 Full Name and Birthdate
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Person #9 Full Name and Birthdate
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What is the address where you live? Please include your town and your apartment number!* This field is required.
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Is anyone in your household a US military veteran or active-duty serviceman?* This field is required.
Yes
No
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Thank you for your service! What is their name?
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Have we recently helped you connect with another organization?Such as General Assistance, ILAP, a senator’s office, a case manager, an outreach worker, etc.
YESNO
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Does someone in your household work?* This field is required.
Yes
No
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If not, why not?
Retired
Disability or illness
No work permit
Currently applying for jobs
Not working
Other
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Other:
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Do you have transportation to the grocery store?* This field is required.
Yes
No
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Think about all of the fresh fruits and vegetables you ate over the past month. Did the majority of them come from Trinity's food pantry?* This field is required.
Yes
No
N/A: This is my first time using your food pantry
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Client Information Tracking Sheet: Lewiston-Auburn Metropolitan Statistical Area The City of Lewiston has been awarded Community Development Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development. The proposed activity/ies are for the Trinity Jubilee Center. For the proposed activity/ties, the CDBG program requires documentation of program benefit. Therefore, the Trinity Jubilee Center is surveying the potential beneficiaries ensuring compliance with CDBG program regulations. Your response to the following questions is critical for meeting CDBG program requirements. All responses are confidential and used solely for securing CDBG grant funds. THIS INFORMATION WILL BE KEPT CONFIDENTIAL.
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Based on the previous "Client Information Tracking Sheet: Lewiston-Auburn Metropolitan Statistical Area" chart, please select your income limit:* This field is required.
Extremely low
Low
Moderate
Over 80% MFI
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Do you live in Lewiston?* This field is required.
Yes
No
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I certify that all information provided is accurate.* This field is required.Signature:
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Date* This field is required.
Date
Year
Month
Day
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Image Field
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Please upload proof of your address. This can be a bill, a lease, a DHHS statement, or other official mail. It must have been issued less than 60 days ago and have your full name and address on it.* This field is required.If you do not have it available right now you can upload it later. Your application will be incomplete until this proof is received.
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Max. file size: 10.6MB
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If you would like to enroll in our Diaper Bank, please upload proof of your child's name and birthdate. This can be a birth certificate, Mainecare card, passport, or other official document. We provide diapers to children under 48 months.If you do not have it available right now you can upload it later. You must provide this proof before receiving diapers.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
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Signature:* This field is required.By my signature below, I release the Trinity Jubilee Center and the original donor from any liability or harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and covenant not to sue the released parties with respect to such harm or losses. I understand that the Trinity Jubilee Center operates on limited funds and in support of others, and I will only request and take items that I reasonably expect myself and/or my family to use. My household will not receive food from the Trinity Jubilee Center’s food pantry more than once per week.
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Do you have feedback for us?We know the Food Pantry is busy and there's not a lot of time to talk! We would love to hear from you! What could we do to make the Food Pantry better?
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