Sonoma Family Meal Application
Sonoma Family Meal began a pilot program in early Dec. 2017 to provide meal assistance to families impacted by the California wildfires. Families interested in our pilot program will be asked to give feedback and opinions on the program so that we can assess how to best serve families on an ongoing basis. Clients will receive at least four family meals per week. Selection will be based on need and alignment with our mission.

Filling out an application does NOT insure acceptance in the program. An intake coordinator will contact those who may best be served by our program.

Email address *
Potential Client Form
Name of Family Member Applying: *
Your answer
Current Address *
Your answer
Best Phone Number *
Your answer
Best Email Address *
Your answer
What affect did the fires have on your family (select all that apply) *
Required
How many people are you feeding? *
Your answer
What type of cooking appliances do you have in your current living situation *
Required
How many are children? *
Your answer
Briefly explain why Sonoma Family Meal would help your family *
Your answer
Do you currently receive food assistance? *
Are you receiving insurance funds to pay for food? *
Would you be interested or able to pay for meals on a sliding scale? *
Anything else you would like to add?
Your answer
Information about application
Based on your answers, an intake coordinator may contact you for final intake into the program. Those not selected for the pilot program will be placed on a waiting list as we roll out more SFM programs.

You agree that the information/answers provided are complete and true and further agree to the following: I understand that it is my decision to accept food from SFM. I relinquish Sonoma Family Meal from all liability of any nature whatsoever and accept the food at my own risk. There is no guarantee to the amount or type of food product given. I will not sell the food or non-food products or exchange /barter food or nonfood products for services. Inappropriate behavior such as profanity, verbal abuse of our staff/volunteers or any other disruptive behavior is prohibited. Any such behavior will result in suspension or termination of your privileges at SFM.

Consent for Release of Information: I understand that Sonoma Family Meal, (a non-profit meal program based in Santa Rosa, CA), will have access to this information for the purposes of overall program evaluation and eligibility. SFM will never share my information. My name or any identifying information will never appear in any reports. I understand that no names or other identifying participant information will be released in SFM promotional materials unless consent is given.

We do not discriminate on the basis of race, color, national origin, sex, age, or disability, but may refer applicants to other agencies that can better serve specific needs.

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