Matthew 25 Alive Outreach Center, Food Pantry
This form is NOT your appointment.  Please complete this form, and you will receive a call back to schedule your appointment. Call the church with any questions, 216-332-9673, ext. 1140.  For other food pantry locations, call the Greater Cleveland Food Bank, 216-738-2067 or United Way, First Call For Help, 2-1-1.
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First and Last Name *
Telephone Number (include the area code)                     *
Example: 216-555-1234
Email Address
Mailing Address (include city and zip code) *
Example: 1234 Food Lane, Cleveland 44001
How many other seniors (age 65 and over) are in your home? *
How many other adults (age 18 - 64) are in your home? *
How many children (age newborn to 17) are in your home? *
Any additional comments?
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