NeighborShare Recipient Application
This application lets us know you're interested in receiving box delivery. Once we process your application we will follow-up with you and let you know how soon we can match you with a delivery volunteer!

Delivery is currently only available in the Midlands counties of South Carolina.
Email Address
Your answer
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Phone *
Example: 123-456-7890
Your answer
Please let us know how you would describe the part of town where you live.
Columbia Area: *
If you live outside of Columbia, please let us know your county. (Select from drop down menu.)
We are currently only able to serve the South Carolina counties listed in drop-down menu below. If you are not in one of these counties, select "Other" and we will keep your information on file to follow-up as we expand in the future.

Other County
Thanks for requesting assistance through NeighborShare. Can you tell us a little more about you?
Do you receive SNAP/EBT? *
Do you have a primary care physician? *
If yes, please provide your doctor's name:
Your answer
Do you have your own transportation? *
Please Answer Yes or No to the following two questions:
Within the past 12 months, I worried whether our food would run out before I had money to buy more. *
Within the past 12 months, the food I bought just didn’t last and I didn’t have money to get more. *
Please share anything else about yourself that you would like us to know.
More about me:
Your answer
Almost done!
Please select your level of assistance needed below (Check all that apply.) *
Required
Thanks so much for filling this application out! Please hit the "SUBMIT" button below and we'll be in touch!
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