Elite Learners, Inc. SCN- "Let's Eat" Food Pantry Screener 
This form helps Elite Learners, Inc. understand the needs of individuals and families in our community.
The information collected will be used to connect you to food resources and other supportive services.
Please complete all required sections.
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Names of Participants *
Each participant receiving food must be listed below
Name: Last, First *
Preferred Spoken Languages: *
If selected "other", please specify:
Do you have any of the following: Select All *
Required
*
Date of Birth: *
MM
/
DD
/
YYYY
Address: *
Phone Number:
Email Address: 
Preferred Written Language: *
If selected "Other" Please specify
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