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Please take a moment to answer all questions so that we may serve you better. We are required to obtain the following information from our clients for funding and reporting purposes; however, we will serve anyone in need regardless of ethnicity, race, color, national origin, sex, age, disability or political beliefs. This information is confidential and will not have a negative effect on services provided to you. NOTE: you will need proof of identity for all members of your household in order to complete this form. Proof of identity includes: driver’s license, photo ID card, permanent resident card, birth certificate, military ID, immigration documents, citizenship or naturalization certificate. Social Security cards are not an acceptable form of identification.

This table below shows a yearly gross income for each family size. If your household is at or below the income listed for the number of people in your household, you are eligible to receive food.