Fruit of the Vine Food Shelf Delivery Request
As a ministry of the Duluth Vineyard Church, we are currently offering this delivery service as a response to the need in our community during the pandemic. In order to serve the most vulnerable and in need of delivery as quickly as we can, we ask that if you are able to make it to the food shelf in person, or send someone to pick up for you, during our normal hours with a signed note or copy of your ID, please do so. Our normal distribution times are on Tuesdays 6-8pm and Saturdays 9:30-11:30am at the Duluth Vineyard Church. We ask that you save this service for those who have no other way to get their groceries. Deliveries are made by volunteer drivers, and are limited by the number available and their work schedules. We trust you to be mindful of those that are in the most need of this service when you consider whether or not you need this service.

If you do need this service, then we invite you to fill out the form below to request food shelf delivery. We will contact you by phone within 1 week with information about the status of your delivery request. If we are unable to fulfill all requests, decisions will be made by staff and leadership on a case by case basis, and according to need and volunteer availability.

Guests can receive food as often as twice a month, whether through this delivery service or during our normal hours. If your request is approved, it is a one-time service. If you need a delivery again, please fill out this form again to put in another request. Please make sure all information on this form is accurate so we can follow up with you if we are able to deliver.

Because our service is based upon availability of our volunteers and priority of needs, your delivery can take anywhere between 1 day and 1 week. We appreciate your patience and if you have any questions please contact our office at 218-525-3462.

Concerning our last question on this form about delivering without the need of contact, please answer no if you are in an apartment building. Only answer yes, if you have a front door that you would be willing to have your groceries dropped off at. We are unable to do a delivery drop off without a recipient present at other drop-off points (i.e by or in an unlocked vehicle, near addresses, cross streets etc.). This helps us to keep our volunteers safe and your groceries safe. Thank you for understanding.

For questions or concerns, or help filling out this form please call the Duluth Vineyard Office at (218) 525-3462.
Sign in to Google to save your progress. Learn more
How it will work
If we are able to deliver to you, here's how it will work:
1) You fill out this form for a one-time delivery
2) Wait for a phone call within a week to see when we are able to fulfill your request.
3) A volunteer from our church will receive your name, phone number, and address, and will follow up with you directly about the best time to deliver.
4) A volunteer will drop off the food at your location at the time you have discussed and notify you that they have completed the delivery. Due to the COVID-19 pandemic, we are asking volunteers to drop food off and notify you by phone that it's there, instead of interacting in person to keep everyone safe and healthy
5) All groceries are pre-packed based on household size and cannot be customized unless for an allergy or medical-related reason (if so, there is a place to indicate that on this form). If you are unable to use any food items you receive, feel free to pass them along to someone who needs them!
6) Enjoy your food!

Find more information on our website: http://duluthvineyard.org/ministries/fruit-of-the-vine/
Or, on our Facebook page: https://www.facebook.com/duluthFOTV/
TEFAP Eligibility Information (granted to all persons in situations of emergency)
Please read the below information before continuing, and please note that if you submit a request for food shelf delivery through this form, you are stating eligibility.

---------------------------------------------------------------------------------------------------------------------------------------------
MN The Emergency Food Assistance Program (TEFAP) Annual Eligibility Information

I am eligible to receive TEFAP commodity food because I am in Minnesota and because my household income is 300% or less of the Federal Poverty Guidelines. Eligibility is granted to all persons in situations of emergency and distress due to disasters. I am also eligible if I receive or participate in the following services and programs:

_____ MFIP – Minnesota Family Investment Program         _____ Child Care Assistance
_____ GA – General Assistance                       _____ Head Start
_____ SNAP – Supplemental Nutritional Assistance Program _____ Section 8
_____ NAPS – Nutritional Assistance Program for Seniors _____ Public Housing
_____ WIC – Women, Infants, and Children                _____ Energy Assistance
_____ Free and reduced breakfast and lunch         _____ Weatherization

Income Eligibility: (300% of Federal Poverty Guidelines)

Family size                         Annual Income
One                                      $0 - $38,280
Two                        $38,281 - $51,720
Three                                   $51,721 - $65,160
Four                                     $65,161 - $78,600
Five                                     $78,601 - $92,040
Six                                       $92,041 - $105,480
Seven                                  $105,481 - $118,920
Eight                                   $118,921 - $132,360
Add $4,480 of allowable income for each additional family member.


Eligibility is granted to all persons in situations of emergency and distress due to disasters.

We are an Equal Opportunity Employer
Primary Contact Full Name *
Have you received food from our food shelf before?
Clear selection
Primary Contact birthdate
MM
/
DD
/
YYYY
Phone Number *
Another way to reach you if we can't via phone (secondary phone or email, or case worker or advocate if applicable) *
Number of people currently living in your household *
Names of each other person in your household *
Birthdays of each person in your household
Address (delivery limited to Duluth, Hermantown, and Proctor). *
Delivery instructions (i.e "leave it at the back entrance"). If no special instructions, write "N/A" *
Neighborhood/ Area *
Reason you are unable to attend the food shelf or send someone to pick up for you during normal hours *
Have you received food from us this month? (Everyone is limited to 2 deliveries per month) *
Any allergies or medical-related dietary restrictions?
If we can not get a hold of you, would you like for our volunteer to leave your delivery at your door? (If checked no, we will not deliver until we make contact with you; please check no if you live in an apartment building)
Clear selection
Additional help
How can we be praying for you?
You have rights under the Minnesota Government Data Practices Act. This Act protects your privacy. We are asking for information so we can: tell you apart from other persons with a similar name and decide how to serve you best. Generally, you are not required to give us the information. However, without it, we can’t report accurate statistics which affects funding. The law allows us to share your information (the number of children, adults, and seniors in your household and the number of pounds of food received) with staff from the Department of Human Services, Hunger Solutions Minnesota, and your regional food bank. You also have the right to copies of information we have about you. If you do not understand the information, it may be explained to you. If you do not think the information is accurate or complete, please correct it with the food shelf staff. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Vineyard Church. Report Abuse
Google Forms