Food Distribution Partner Application
Contact Information
Name of Organization:
*
Address of Organization:
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Address where food distributions will take place (if different from above):
Street Address
Street Address Line 2
City
State / Province
Zip Code
Contact Person:
*
First Name
Last Name
Contact Person Title:
*
i.e. Executive Director, Program Manager, etc.
Contact Person Email:
*
example@example.com
Phone Number:
*
-
Area Code
Phone Number
Does your organization have a website or Facebook page?
Copy & Paste URL above
How did you hear about us?
*
North Texas Food Bank
Web Search
Former Food Distribution Partner
Current Former Food Distribution Partner
Other
Organization/Program Information
Does your organization have tax exempt status under section 501(c)(3) from the Internal Revenue Service (IRS)?:
*
Yes
No
Please provide your organizations EIN/Tax ID Number:
*
i.e. XX-XXXXXXX
Please upload your IRS Determination Letter
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Is your food assistance program operated under the umbrella of another 501(c)(3) organization or church? (i.e. church that is part of a larger church body such as General Baptist Convention or agency that operates under the “umbrella” of a non-profit 501(c)(3) charity):
*
Yes
No
Other
What is the name of the organization or church that your program will operate under?:
i.e. Christian Methodist Episcopal Church, Baptist General Convention of Texas, etc.
Umbrella Organization Tax ID number:
*
i.e. XX-XXXXXXX
Does your organization currently provide food assistance?:
*
Yes
No
Other
If yes, when did your organization begin providing food assistance?
-
Month
-
Day
Year
Date
Does your organization have an existing board-approved food budget?
*
Yes
No
If requested, could your organizations provide a record of monthly expenditures for its food program for the past three months?
*
Yes
No
N/A
What county(ies) does your organization wish to provide food assistance programs to?
*
Dallas
Ellis
Navarro
Other
Please list all zip codes that your food assistance program will serve:
*
Does your organization have the ability to store food product in a temperature controlled, non-residential facility?
*
Yes
No
How often will your organization provide food assistance?:
*
Year-Round
Once per month
Once per week
When we have food to distribute
Other
In what way(s) does your organization plan to distribute food?: (Check all that apply)
*
We will have a food pantry clients can visit
We will cook food for those in need
We will deliver food to clients in need
We will pack boxes for client pick up
Other
If your organization currently distributes food, please list the number of clients that receive food each month:
*
What are your current sources of food if any?: (Check all that apply)
*
Purchased (grocery store, Costco, Sam's Club, Walmart, etc.)
Donations from Retail/Grocery Stores
Donations from individuals (i.e. food drives)
No food sources at this time
Other
Which of the following represents the target population of your program or organization? (Select all that apply):
*
Children (0-17)
Adults (18-59)
Seniors (60+)
Homeless individuals/families
Persons with disabilities
Persons affected by substance abuse
Victims of domestic violence
Veterans/Military
Not currently serving any clients
Other
Does your organization have any of the following?
*
Refrigerator
Freezer
Climate-Controlled Storage Space (pantry/shelving)
Locked filing cabinet/closet to store paperwork
Wi-Fi
None of the above
How often will your organization distribute food?:
*
Daily
Weekly
Monthly
Other
Is your organization a religious organization (a church, nondenominational ministry, interdenominational and ecumenical organization, or other entity whose principal purpose is the study or advancement of religion)?
*
Yes
No
Is your organization comfortable using an income-based qualifier such as the Federal Poverty Limit Guidelines to determine who is eligible to receive food assistance?
*
Yes
No
What is your organization's mission?
*
ex. purpose/mission, programs, etc.
Please give a summary of your organizations current program(s) if any:
*
How does your organization plan to use its partnership with Crossroads Community Services to better serve your clients?
*
Additional comments
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