Hallie Q. Brown Food Shelf Request Form
Welcome to Hallie Q. Brown Community Center. During the COVID-19 pandemic, we have restructured our food shelf operations to offer the ability to place your request online through this form.  Please fill out the form below and submit.  HQB staff will review your request and contact you to confirm a time for pick up/delivery. If you have any questions please contact our Food Shelf Coordinator, Althea Lankford at alankford@hallieqbrown.org or 651-224 4606. Please stay safe and well.
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Name *
Address *
Phone number *
Email Address *
How many children (age 0-17 years) are in your household? *
How many adults (age 18-64 years) are in your household? *
How many seniors (age 65+ years) are in your household? *
Are you a current HQB Food Shelf Client *
Required
How would you like to receive your food box? Please select one of the options below and a HQB Staff or Volunteer will contact you to confirm your time? *
Required
Please select any food items you DO NOT want/need. All other items will be included and packed in your box.  Please note: our food supplies change daily and every item may not be available. We will do our best to accommodate your requests. Remember only check boxes of food you DO NOT want/need. Write in any special items not listed in the box below and we will do our best to accommodate that. *
Required
Please list any dietary restrictions *
List any Household and/or Hygiene items needed here:
Is there anything else you would like us to know to help serve you?
Prefer for notification: *
Required
We hope you find this helpful.  If you have any other needs or need to be contact with other staff, please feel free to submit comments below or call us at 651-224-4601. We are here to help.
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