Harvest House
Food Pantry
FOOD ASSISTANCE APPLICATION
You Can Print This Card or You Can Download The File Below and Print
FOOD ASSISTANCE APPLICATION
Please fill out and return to drop box in front of harvest house building or give to harvest house volunteer.
NAME: ______________________________________________
ADDRESS: __________________________________________
AGE: __________________________
GENDER: O MALE O FEMALE
DO YOU HAVE A SPOUSE? O YES O NO
WHAT IS YOUR HOUSEHOLD INCOME? __________________
HOUEHOLD NUMBER? _______
DO YOU RECEIVE SNAP (FOOD STAMPS)? _________
HOW MUCH SNAP DO YOU RECEIVE? _____________