Black Cultural Initiative: Food Distribution Center Sign Up

Welcome to the Black Cultural Initiative Food Distribution Center

We are excited to partner with local ranchers and farmers to increase access to whole foods, with a priority on serving historically and currently marginalized community members.

Our Food Distribution Center provides locally produced whole foods to individuals and families who need them most. We focus on:

  • Red meats (beef, lamb, goat)

  • Poultry and pork

  • Seasonal fresh fruits and vegetables

You can receive food either by picking up on-site or through home delivery (when available). We also provide culturally specific whole foods to better meet the needs of our community.

Please note:

  • Filling out this form does not guarantee food. Please wait for confirmation from our team.

  • You must fill out this form each time you would like to receive food.

  • Available foods and pick-up dates/times will be updated twice a month.

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Email *
Head of Household Name (Your Full Name) *
Head of Household Age (Your Age) *
If there is an additional head of household, please list their name & age here:
*Or type N/A
Cell Phone Number *
How many people are in your household?
*Please include yourself
 *
How many people in your household are under 18? *
What is your race and/or ethnicity?
*Please check all that apply
 *
Required
If there is an additional head of household, what is their race and/or ethnicity?
*Please check all that apply
 *
Required
How many people in your household identify as:
-Black
-African American 
-African
-African descent 
-Afro-Caribbean 
-Afro-Asian
 *
How many people in your household identify as:
-Indigenous
-Native
-Native Alaskan
-Native Hawaiian
 *
How many people in your household identify as BIPOC? *
Do you receive government assistance?
 *
Required
What is your household's monthly income?
*Your answer will not negatively impact your ability to access any of the above forms of assistance!
 *
From the options below, how do you identify your income? *
Do you or anyone in your household require special accommodations to participate in this program? *
What culturally specific foods and matching recipes would you like to receive?  (Check all that apply)
*THESE CHOICES WILL BE UPDATED DEPENDING ON AVAILABILITY!
 *
Required
Do you have any dietary restrictions? *
IF we are able to give you food, which Saturdays could you come pick it up?
*WE WILL LET YOU KNOW ASAP IF WE ARE ABLE TO SERVE YOU 
*THESE DATES WILL BE UPDATED TWICE A MONTH!
 *
Required
To participate, would you need your food delivered? *
If yes, please provide your FULL address below 
AND state the reason WHY you are only able to access this food opportunity via deliveries
I understand that filling out this form does not guarantee that food will be available for pick up or deliver. I will wait to hear back for confirmation of what is available.  *
Required
How did you hear about the food distribution program? *
We are always looking to improve.  
Please provide any additional feedback here.
 *
MEDIA RELEASE
The Black Cultural Initiative has my permission to use my, photographs, video and audio publicly to promote the program. I understand that the images may be used in print brochures, websites, and social media. I also understand that no royalty, fee or other compensation will be payable to me or the minor under my care. *
MINOR MEDIA RELEASE
The Black Cultural Initiative has my permission to use photographs, video and audio publicly of the minor under my care to promote the program. I understand that the images may be used in print brochures, websites, and social media. I also understand that no royalty, fee or other compensation will be payable to me.
 *
Thank you!
If you are filling this form out off site rather than during one of our programs onsite, we will reach out to you about potential food pick up and deliveries as soon as possible.
Please know that filling out this form does not guarantee access, we will reach out to tell you if we are able to provide. 
Feel free to reach out with any questions or concerns.
Michelle Hjelm
Michelle@BlackCulturalinitiative.org
A copy of your responses will be emailed to the address you provided.
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