Disaster Food Connect - Intake Form
The Cape Fear Food Council, UNCW Sustainability, and the UNCW Center for Healthy Communities created Disaster Food Connect as a centralized system of communication and coordination between food relief organizations in and around New Hanover County. The goal is to avoid duplication of efforts, identity service area gaps, and maximize resources during the community's recovery after a natural disaster occurs.

This intake form is intended to gather your organization's contact information, type(s) of services provided, and the geographic scope of your efforts. By completing this form, you understand the information collected will be shared among other members of the Disaster Food Connect network. Your information will not shared publicly or beyond this network, unless we request your permission.

Contact us at (252) 531-4566 or DisasterFoodConnect@gmail.com with any questions.
Organization
Your answer
Primary Street Address
Your answer
Primary Zip Code
Your answer
Primary Contact Name
Your answer
Title, If Applicable
Your answer
E-mail
Your answer
Text Capable Phone
Your answer
Do you prefer to be contacted by text or phone call for status updates?
Additional Contacts
Please list additional contacts from your organization that we can reach if you are unavailable.
Additional Contact Name #1
Your answer
Title, If Applicable
Your answer
E-mail
Your answer
Text Capable Phone
Your answer
Additional Contact Name #2
Your answer
Title, If Applicable
Your answer
E-mail
Your answer
Text Capable Phone
Your answer
Services & Location
Are you serving hot meals? Select all that apply.
Where are you offering food distribution services? Select all that apply.
If you are offering hot meals and/or a food pantry at your primary location, what are the days and hours of operation?
Your answer
Door-to-Door Delivery
If you are delivering food to residences, please identify your service area. This information will be used to help avoid duplication of efforts and identify gaps in service.
Neighborhood Name(s) | Housing Unit Name(s)
Your answer
Zip Codes Served, If Known
Your answer
Days/Hours of Operation for Food Delivery Services
Your answer
Pop-Up/Secondary Locations
If you are serving food at pop-up/secondary locations, please identify your service area. This information will be used to help avoid duplication of efforts and identify gaps in service.
Neighborhood(s) Names | Housing Unit Name(s)
Your answer
Zip Codes Served, If Known
Your answer
Days/Hours of Operation at Pop-Up/Secondary Locations
Your answer
Additional Information
Any additional information/comments/needs related to your food relief services?
Your answer
What other organizations providing food relief services should we contact to be involved in Disaster Food Connect? Please provide name(s) and contact information, if possible.
Your answer
Get link
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy