Who is the head of the household that will pick up the food?
County: Feeding Hands serves residents in these local areas.*
Are you receiving any of the following governmental assistance? Check all that apply.
Was your family income reduced because of COVID-19?*
Are you having difficulty affording your housing or other basic needs?*
Either an email or phone number is required to get your appointment. If you do not have a phone, please provide the number of someone who can get messages for you.
Is this a cell phone number?*
Do you want to receive your client number and appointment time via email or text?*
Select a timeframe/location for your appointment?*
Conditions to Receive Assistance*
As conditions for receiving assistance, I acknowledge, consent to, and certify the following: (Check all to acknowledge your agreement.)
By typing your full name, you acknowledge, consent, and certify to the above information.
If you provided an email address, you will immediately receive an email confirmation from firstname.lastname@example.org. Please check your Junk Email folder if you do not see the message in your Inbox.
Within the next few days, you will receive a client number (required at your first appointment) and appointment day and time via email or text. You can receive food once a month by appointment.
Please bring the following to your appointments:
Client card (you will receive this on your first visit)
Proof of address (electric bill, phone bill, or other document with your name and physical address)