HHYC Food Bank Application
Please fill out the following information in order to apply for monthly food boxes from the Helping Hands Youth Center (HHYC) Food Bank. All food bank decisions are based solely on the need of the applicant. HHYC will not base any decisions on race, gender, religion, etc.
Completion of this form does not ensure acceptance into the food bank program. Please allow three business days for a HHYC representative to contact you concerning eligibility.
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Full Government Name *
What is your date of birth? *
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Are you considered homeless according to the McKinney-Vento Homeless Assistance Act? See the full definition here: https://nche.ed.gov/mckinney-vento-definition/ *
What is your physical address? If you do not have a physical address, please enter "N/A" *
What is your mailing address? If you do not have a mailing address, please enter "N/A" *
What is your phone number? If you do not have a phone number, please enter "N/A" *
What is your email address?  If you do not have an email, please enter "N/A" *
Are you, or anyone in your household, a veteran? *
Do you, or anyone in your household, have tribal affiliations? *
How many people are living in your household? *
How many members of your household will need food bank assistance?
What is your household income before taxes are withheld? Do not include any government assistance amounts. *
Does your household receive assistance from any government programs? If so, please check the box next to those programs received.
Why do you need assistance from our food bank? Please inform us of any circumstances/situations that will help us better serve you.
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