Monthly Report
Please enter in your information below for your monthly report. If you have any difficulties or questions, please contact Dianne Layden at dlayden@feedingamerica.org or (252) 335-4035 x104.
Email address *
Month *
Year *
Agency Submitting Report *
Your answer
Town in which Agency is located: *
Your answer
Zipcode of Agency: *
Your answer
Individual Submitting Report *
Your answer
Type of Agency *
Primary County Served *
Number of BLACK families/households helped last month? *
Your answer
Number of WHITE families/households helped last month? *
Your answer
Number of HISPANIC families/households helped last month? *
Your answer
Number of ASIAN families/households helped last month? *
Your answer
Number of AMERICAN INDIAN families/households helped last month? *
Your answer
How many OTHER RACE/ UNDECLARED families/households helped last month? *
Your answer
How many households have at least one person who is employed? *
Your answer
How many households receive Food Stamps (FNS)? *
Your answer
How many households received disaster relief assistance? *
Your answer
TOTAL Families/Households helped last month? *
Your answer
Of the total families/households helped last month, how many were new (first visit) to your agency? *
Your answer
How many individuals were aged: 0-4 Years Old *
Your answer
5-17 Years Old *
Your answer
18-64 Years Old *
Your answer
65+ Years Old *
Your answer
TOTAL INDIVIDUALS ASSISTED: *
Your answer
We served households who live in zip code:
Please list the zip code, followed by a dash - and then the household number. Please put each zipcode on a separate line. For example: "27909 - 56"
Your answer
Phone Number of person completing report:
Your answer
A copy of your responses will be emailed to the address you provided.
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