Harvest Monthly Report
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Email *
Month:  *
Agency Name *
Name of Person Completing Report *
Total Number of Families/Households Receiving Food Assistance From Your Program *
Total Number of Individuals Receiving Food Assistance From Your Program
 *
Total Number of Families Receiving help for the First Time This Month: *
Supplemental Nutrition Assistance Program - SNAP Outreach (Number of Applications):
Of The Individuals Reported how many are Children (0-18)? *
Of The Individuals Reported how many are Adults (19-59)?
 *
Of The Individuals Reported how many are Seniors (60 & Above)?
 *
Total Children, Adults, & Seniors: *
Of The Individuals Reported how many are African American?
 *
Of The Individuals Reported how many are Caucasian (White)?
 *
Of The Individuals Reported how many are  Hispanic?
 *
Of The Individuals Reported how many are Native American? 
 *
Of The Individuals Reported how many are Asian?
 *
Of The Individuals Reported how many are a Race/Ethnicity not listed above?
 *
Total of Races/Ethnicities: *

Report total pounds received from other sources: (Other Food Banks, Individual Donations, Food Purchased from Wholesales or Retailers, Food Drives Donated to your Organization, Other Retailer or Manufacturer Direct Donations, etc…)

 *
Does your agency serve meals? *
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