COVID-19 Relief (Grab-and-Go) Food Assistance
Agency: Hardee Help Center
713 East Bay Street
Wauchula, FL 33873
Tele: 863-773-0034

Food assistance for Hardee County families impacted by COVID-19 is available. 
This food assistance is offered to households who have experienced job loss or loss of hours due to mitigating efforts associated with the coronavirus outbreak and/or in quarantine.

Documents needed:
Photo Identification
Proof of job loss or loss of hours (i.e., employer's name and phone number)
Proof of local residence

Documents can be emailed to: applications@hardeehelpcenter.com or presented when picking up your food order. Food orders will be delivered to families in quarantine.

Submit your registration and you will be contacted by phone or email by a Hardee Help Center Team Member.

Please submit only one registration per physical address.

>>>> Applicant must be the person who is registering/completing this form and certify the information provided is accurate.
Email address *
Applicant First, Last Name (Adult Household Member) *
Are you a member of a local church? If so, which church. *
Phone Number (xxx-xxx-xxxx) *
Current Physical Address (Ex. 713 E. Bay Street, Wauchula) *
Adult Household Member DOB *
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Adult Household Member Last Four Social Security Numbers (xxxx) *
Gender? *
Adult Household Member Marital Status: *
Disabled? *
Veteran? *
Race? *
Required
Ethnicity? *
Housing? *
Number of Household Members? *
How many children under 17 yrs or younger live in your home? *
Residency? *
Required
Total Monthly Household Income (Ex. $1,200) *
Total Monthly Household Expenses ($1,100) *
Do you receive SNAP assistance (food stamps)? If yes, how much? If no, have you applied? *
Are you aware of other food pantries? *
How has COVID-19 affected your household income? *
Have you or another adult household member experienced one of the following events? *
Provide your employer's business name, supervisor/manager's name and phone number. *
Do you have other needs due to the impact of COVID-19? *
Have you been assisted by the Hardee Help Center in prior years, if so, how? *
Anything else you would like us to know? *
I acknowledge the information I submitted above, or by phone with Hardee Help Center Personnel was truthful and accurate. No fraudulent information was provided in order to obtain services that I would otherwise not likely qualify for. *
I acknowledge the information I have provided is shared with the local churches, as the Hardee Help Center is a ministry of the Hardee County Ministerial Association. That any willful misstatement of information will be grounds for disqualification AND I may no longer receive assistance through the Hardee Help Center in the future. *
By selecting 'Yes' below I hereby authorize the release without liability, information regarding my residency, employment, income, and/or assets to HARDEE HELP CENTER, for the purposes of verifying information provided as part of determining eligibility for assistance under the Hardee Help Center’s Basic Need Program. I understand that only information necessary for determining eligibility can be requested. Types of Information to be verified: I understand that previous or current information regarding me may be required. Verification that may be requested are, but not limited to: employment history, hours worked, salary and payment frequency, commissions, raises, bonuses, and tips; cash held in checking/savings accounts, stocks, bonds, certificated of deposits, Individual Retirement Accounts, interest, dividends; payments from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits, unemployment, disability or worker’s compensation, net income from the operation of a business, property exemption status, and alimony or child support payments. *
Signature is required. By typing your name below, this is your digital signature. You are signing this Form electronically. *
Date Submitted *
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