Partner Agencies
partnership application

Fields shaded in yellow are required.. Please make sure you read and understand the Operational Requirements for all Partner Organizations. A PDF version of this form can be downloaded here.

   
Agency ID:
Date:
Please Choose One:
Organization Name:
Address1:
Address2:
City: County:
State: Zip Code:
Mailing Address:    
Address1:
Address2:
City: County:
State: Zip Code:
Years at Above Address: Telephone:
Fax: Email:
Director of Organization:
  Title:
  Telephone:
Food Program Director:
  Title:
  Telephone:
Is your agency an affiliate of a larger organization?


 
 
Organization Name:
Address1:
Address2:
City: County:
State: Zip Code:
Telephone:    
 
THE FOLLOWING REQUIREMENTS MUST BE MET BY ALL APPLICANTS:
  1. A valid 501(c)(3) authorization letter issued by the Federal Internal Revenue Service.
  2. Proof that your organization has been operating an established food or service program for the last 3 months.
  3. Regular days and hours of operation.
  4. Adequate on site clean, secure, and rodent free storage space (dry, refrigerated, and frozen if required).
  5. Programs that prepare and serve meals on site must possess a current health certificate. Food preparation staff must be trained in food safety and handling. (Please provide copies of all documents).
  6. A letter describing your program and guidelines used to determine individual and/or family eligibility for food assistance, and how FoodBank partnership will help your program.
  7. All other requirements as indicated on the Operational Requirements for All Partner Agencies.
 
Check all that correspond to your agency and fill out all fields in the respective section(s).
 





Others:
Emergency Pantry
What are your days and hours of operation?
 
Day of Week
Hours  
Day of Week
Hours
   
   
   
       
Total Number of Hours Available:
How does someone needing help find out about your program?
What is the average number of families in each category?
 
 
 
Do you charge for food?    
What screening process does your agency use to determine whether a potential client is needy?
Percentage of clients who are low-income:
How often can a client come back for food?   
How many days supply of food do they receive?
Does your pantry accept referrals?   
   From whom?
Do you accept walk-ins?   
Do you deliver food to your clients?    
Do you keep records on your clients?   
How many clients do you serve per month?
What other services does your agency provide?
What are your sources of food other than the FoodBank?
Do people of all races and religions have equal access to the services provided by your agency?    
  Please explain:
Do you have on-site dry, refrigerated, and freezer storage?   
   Size of refrigerator
   Size of freezer

Authorized Shoppers: (No more than two)
   
   
Soup Kitchen
What are your days and hours of operation?
 
Day of Week
Hours  
Day of Week
Hours
   
   
   
       
What are the number of clients in each category?
 
 
 
How many people participate in your program monthly?
Percentage of clients served who are low-income?
Are clients charged?

  

How many times can a client return?
Do you keep records on your clients?   
Do you have a valid health certificate?   
   *Please present a copy at initial interview  
Do you participate in the U.S.D.A. Soup Kitchen Commodity Program ?   
What are your sources of funding?
Do you provide meals to staff?   
   How many staff members?
Do you have on-site dry, refrigerated, and freezer storage?   
   Size of refrigerator
   Size of freezer
Do you prepare meals on-site?   
Please indicate meal schedule:  
     
Number of Meals Served Per:
Day
Week
Month
  Breakfast
 
S
M
T
W
T
F
S
 
Hours:
  Lunch
 
S
M
T
W
T
F
S
 
Hours:
  Dinner/Supper
 
S
M
T
W
T
F
S
 
Hours:
  Snack(s)
 
S
M
T
W
T
F
S
 
Hours:
 

Authorized Shoppers: (No more than two)