SNAP Referral Form
The Akron-Canton Regional Foodbank is available to assist the community with applying for SNAP benefits (formerly known as food stamps) over the phone. Complete this form if you would like to be contacted by a staff member to apply for this important resource, or if you need information about food pantries and hot meals in your area.
First and Last Name *
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
County
Phone Number *
Your answer
Best Time to Call
Are you currently receiving SNAP (Food Assistance/Food Stamps)? *
Income Guidelines
Is your monthly income (before taxes) less than the income guidelines shown above? *
Is there anything you'd like us to know prior to contacting you to complete an application?
Your answer
Agency Referral Information
If you are a partner agency completing this referral for someone else, please complete the information below. We will be in touch if we have any questions about this referral.
Agency Name
Your answer
Agency Contact
Your answer
Agency Phone Number
Your answer
Submit
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