Food Hamper Request Form
Deliveries are on Tuesday's, Thursday's and Saturday's only. Request must be made BEFORE 5pm the day before.


PRIORITY: Individuals and families in ISOLATION will be prioritised first.

Food hamper INCLUDES:
Rice, Pasta, Flour, Fruit and vegetable cans, Long life milk, Tuna, Legumes/lentils, Sugar, Pasta sauce, Cooking oil, Tea bags/coffee and Chocolate/ biscuits.

We do NOT have fresh produce, meat or NON-food items.

The Islamic Council of Victoria is providing food hampers with non-perishable food items to those in need. If you are experiencing hardships have been advised to isolate and need us to send a food hamper (with non-perishable food items), please fill in the below.
Deliveries are on Tuesday's, Thursday's and Saturday's only. Request must be made BEFORE 5pm the day before. *
I understand there is a delay and people/families in isolation will be prioritised however, deliveries may take 2-3 days due to high demand *
First name *
Last name *
Number and street (food hamper will be delivered to you) *
Suburb *
Postcode *
Phone number *
Email address (To confirm the delivery date) *
Accommodation type *
A) Number of people in the household *
B) How many people in the house need food? (do not include yourself) *
Do you require any other assistance? (We will help refer you to a Muslim org for support other than food relief)
Have you been asked to isolate? (Food will still be delivered) *
I understand the hampers are already pre-packaged from the Halal Food Bank and contain the following items *
Captionless Image
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy