JFS Food Pantry Delivery Request
If you are able please attend curbside pick-up on Thursdays from 11am-4pm at the 2245 S. State, Ann Arbor, MI 48104. 

Please call us at 734-769-0209 ex. 6 or email at foodpantry@jfsannarbor.org with any questions or concerns.


Sign in to Google to save your progress. Learn more
The following questions are for reporting purposes only and in no way impact eligibility for programs. Jewish Family Services provides services for all residents of Washtenaw County. We are committed to providing affordable, accessible, holistically-oriented and culturally sensitive care to our clients, whatever their identification, affiliation, lifestyle, background, race, religious creed, or national origin.
What is your full name (First and Last)? *
Are you an existing JFS client? *
What is your street address? *
What is your Zip Code? *
What is your phone number? *
What is your email address?
What is your date of birth? *
MM
/
DD
/
YYYY
What race to you identify as? *
This is used to inform funders of the demographics of the clients served.  
What is your annual income? *
This in no way affects whether or not someone is eligible for services and is captured only for demographic purposes for funders.
What is your religious affiliation? 
How many individuals live in your household? *
Do you have dietary restrictions? *
We will try to accommodate any restrictions but have limited availability.
If you have dietary restrictions, what are they?
How urgent is your need for food? *
Urgency does not determine IF you get the service but helps us prioritize the most urgent needs
Currently out of food
Will be out of food in 7+ days
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jewish Family Services of Washtenaw County. Report Abuse
Google Forms