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Food Pantry Order Form 
11/24/25
This institution is an equal opportunity provider
Please fill out the following order form by checking the items requested.  We will do our best to fill orders as soon as possible, but this will not always be the same day you complete the form.  We will call you when the order is completed and it is your responsibility to pick it up.

All families will be required to have a completed TEFAP Form on file prior to picking up food.
Student Name *
Date Completed *
Phone Number *
Home Address *
Total Number of People in Household *
# in Household ages 0-18 years of age *
# in Household ages 19-50 years of age

 *
# in Household ages 60 years of age and older *
Check Items *
Required
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