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Kelly's Kitchen
13753 N 226 Hwy
Bakersville, NC 28705
eva@kellys-kitchen.org
www.kellys-kitchen.org
2025 Food Security Network Survey
If you have previously filled out our Food Security Network Survey, you do not need to fill this out. This is an updated form for new interested Network members. If you have any questions or need assistance filling out this form, please contact Food Security Network Coordinator Eva Houston at eva@kellys-kitchen.org.
Full Name
*
First Name
Last Name
Personal Phone Number
A phone number we can use to contact you.
Personal Email
*
An email we can use to contact you.
Resource Name
*
Resource Address
*
Street Address
Street Address Line 2
City
State / Territory
Postal / Zip Code
Mailing Address (if different from physical)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Phone Number
A phone number the public can call.
Organization Email
An email the public can use.
Website/Social Media
Please include Facebook and/or Instagram handles if you have them.
Days Open and Hours of Operation
*
Hours and days of the week that your location is open to visits from other organizations or community members
Eligibility Requirements
*
What are the requirements necessary for someone to utilize services or supports your organization offers?
What type of food resource are you? (choose all that apply)
*
Food pantry
Food bank
Food co-op
Farm
Restaurant
Community garden
Other (specify below)
If you chose "other" above, please describe your food resource.
What kind of food and resources do you provide?
*
What accessibility features do you have? (If you are unsure about the accessibility of your resource or would like more information about this, please let us know that too.)
*
Do you want help making your resource more accessible to people with disabilities? Is there anything else you need support in that you would like help with from Kelly's Kitchen?
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