Emergency Food Gift Card Application

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Please note: This program is currently available only to residents of Mississauga, Brampton, and Caledon. If you live outside of Peel Region, and are an active Care Masters community member you are eligible to apply. Please complete the application accurately so that we can assess your eligibility and support needs. All information provided will be kept confidential.

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The Emergency Food Gift Card Program provides short-term support to individuals and families experiencing financial hardship or food insecurity. Care Masters also offers free programs and services designed to support the health, well-being and stability of individuals and families in our community. As part of your application, you will have the opportunity to let us know about other supports you may be interested in.

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Basic Information

Please provide your personal details so we can contact you and accurately process your application. All information will be kept confidential.

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Full name

First Name

Last Name

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Phone Number

Please enter a valid phone number.

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Email

example@example.com

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Postal code

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Household Information

Please share information about everyone living in your household, including ages. This helps us understand your family’s needs and provide appropriate support.

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Number of dependants

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Number of children under 18

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Are you the primary caregiver?

Yes

No

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Food Security Status

Please answer the following questions about your access to food over the past 30 days. Your responses help us understand your needs and provide the right support.

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In the past 30 days, did you worry that food would run out before you had more?

Often

Sometimes

Rarely

Never

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In the past 30 days, did you skip meals because there wasn't enough money for food?

Yes, frequently

Yes, sometimes

No

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In the past 30 days, did you go a whole day without eating?

Yes

No

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Support Needs

Please provide details about your current circumstances, including your financial situation, how urgently you need food support, and any factors that may make you or your household more vulnerable. Your responses will help us provide the right support quickly and safely.

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How urgent is your need for food support?

Emergency (no food today/tomorrow)

Within 3-5 days

Within 1-2 weeks

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Are you currently accessing any of these?

Food bank

School food program

Community meals

Other

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Where do you typically purchase your groceries?

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How would you like to receive your gift card?

E-gift card via email

Physical gift card picked up at our office in Mississauga

Physical gift card mailed to your home address

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Are you or your child involved in Care Masters programs, activities or events?

YESNO

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If yes, which program, activity or event have you or your child been involved in?

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Would you be interested in participating in a Care Masters program, activity or event ?

Yes

Maybe - I would like more information

No, not at this time

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What free programs, activities or events would you be interested in learning more about? Select all that apply.

Health and wellness programs

Cooking and nutrition workshops

Financial literacy and budgeting programs

Mental health and wellness supports

Youth and family programs

Community events and activities

Not sure - please contact me about programs that may be suitable

None at this time

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May Care Masters contact you about free programs, workshops and services that may be relevant to you or your family?* This field is required.

Yes

No

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How did you learn about this program?

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Consent

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By submitting this form, I confirm that the information I provided is true. I understand it will be used to see if I can receive support through the Emergency Food Gift Card Program and other services in the Food Security Program. I also agree to be contacted about my application and connected to helpful community resources if needed. All information will be kept confidential.

I agree

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Signature (Typed Name)

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Please note: The Emergency Food Gift Card Program is intended to provide short-term assistance. Individuals actively participating in Care Masters programs may be eligible to reapply for additional grocery support while funding and supplies are available. Submission of an application does not guarantee a gift card.

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Date

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Thank you for completing this form. Your responses will help us provide emergency food support and connect you to other resources through our Food Security Program. We will contact you as soon as possible regarding your application.