Greene County  School Distribution Form
Please fill out this form completely so we can use it to check off your family as they pick up food at your school distribution. We use this form to adequately plan the distribution to serve the number of families that plan to attend the distribution.

Por favor complete este formulario por completo para que podamos usarlo para marcar a su familia mientras recogen alimentos en la distribución de su escuela. Usamos este formulario para planificar adecuadamente la distribución para atender al número

(If you need a translation of this form email in the language you speak and we will will assist you in your preferred language)  The calendar for distributions can be found here: 

At the end we have included a short food security survey. Your answers will go into a spreadsheet that doesn't have names or identifying info on it so we can get a temperature map on how people are feeling.
Sign in to Google to save your progress. Learn more
Name of Person picking up food (One person must be present from each household if a car is picking up from more than one household) Nombre de la persona que recoge los alimentos (debe estar presente una persona de cada hogar si un automóvil está recogiendo en más de un hogar)
Which distribution are you attending in January? (Please choice one to attend) ¿A qué distribución asistes? (Elegir uno) *
Contact info (phone number or email address) Información de contacto (número de teléfono o dirección de correo electrónico) *
What County do you live in? ¿En que país vives? *
How many adults live in your house? ¿Cuántos adultos viven en tu casa? *
How many children live in your house? ¿Cuántos niños viven en tu casa? *
Rate how food secure you feel going into the summer: Califique qué tan seguro se siente con respecto a los alimentos al entrar en el verano: *
What program has been most helpful to feed your kids during the school year? *
On a scale of 1-10, 1 being not worried and 10 being panicked, how would you rate your feelings around providing having enough food for this summer             En una escala del 1 al 10, 1 no está preocupado y 10 está en pánico, ¿cómo calificaría sus sentimientos acerca de proporcionar suficiente comida para este verano? *
Not Worried
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy