Bridge Over Troubled Water | Home Delivery Food Pantry Request
Eligibility Questionnaire
Please answer a few questions to determine if we can help.
Do you currently need food assistance?
Yes
No
What makes home delivery necessary?
Age 65 and older
Disabled
Lack of transportation
Caregiving Responsibilities
Homebound
Other
What city do you live in?
Belton
Raymore
Peculiar
Harrisonville
Grandview
South Kansas City
Overland Park, KS
Other
Are you requesting for yourself or someone else?
Myself
Someone else
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How it works
Tell us where to deliver and how to reach you. Select the foods your household would prefer. Our team reviews your request and contacts you about availability and delivery. **Important: Submitting it does not send an order. Delivery areas, eligibility, schedules, food inventory fees must be confirmed by before delivery.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many people in the household?
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Choose Preferred Groceries
Selections are requests, not guarantees. Items depend on donations and inventory.
Dietary Restrictions
Special Requests
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Delivery Preferences
For example: Gate code, Building entrance or preferred drop off instructions
I need help bringing groceries to my door.
I understand this is a request, not a confirmed delivery.
Review My Request
Should be Empty: