New Agency Inquiry - Food Bank of Contra Costa and Solano

If you are interested in becoming a partner of the Food Bank of Contra Costa and Solano and have questions, fill out the form below and you will be contacted.

Date
Agency Name
Address
Street Address City State / Province / Region ZIP / Postal Code
Executive Director
First Last
Phone
Cell
Fax
Email
Billing Address
Street Address City State / Province / Region ZIP / Postal Code
Program Name
Address
Street Address City State / Province / Region ZIP / Postal Code
Program Director
First Last
Phone
Cell
Fax
Email
SHOPPER INFORMATION (Name, Title, Phone) **Please include ALL shoppers
Please Choose Type of Service
- Pantry
- Soup Kitchen
- Residential Program
Days and Times
Population Serving
Notes
For ALL Agencies
When did your food program begin or how long has it been operating?
How much money do you budget each month to purchase food?
Where does this money come from? List sources of funding:
Do you have a refrigerator?
Do you have a freezer?
How do people find out about your program?
Does your agency serve a specific population?
What are your eligibility requirements?
Do you have records of the people receiving food (sign in sheets)?
Do you keep your food receipts for at least one year?
How many people are currently needed to run your food program?
How many people have a current “Servsafe” certification?
For Food Pantries
How many households do you serve in an average month?
How many individuals do you serve in an average month?
What percentage of these people are referred to you?
Do you attempt to qualify the people who are not referred?
If yes, how?
What days and hours are you open?
How many times may someone utilize your program in a month?
What is the phone number people can call for help?
What area do you serve?
What is your pantry distribution procedure?
For Soup Kitchens
Is your kitchen liscensed?
If yes, by what licensing agency?
Which meals do you prepare?
How many meals do you serve in an average month?
Does your meal count reflect people having a second helping?
What percentage of the people you serve are low income?
What percentage of the people you serve are repeats?
Do you serve one age group in particular?
To the best of my knowledge, the information provided above is true and correct.
Agency Representative
First Last
Date
Comments
This field is for validation purposes and should be left unchanged.

For ALL Agencies

For Food Pantries

For Soup Kitchens

To the best of my knowledge, the information provided above is true and correct.

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