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Monthly Reporting for Member Agencies

Please complete your monthly food distribution report in the fields below.

If you prefer, you may download a copy to fill out and mail here.

* Agency Name
* Agency ID Number
* This Report was Prepared By
* Phone Number ( ) -
* E-Mail Address
* Reporting Period
 
IF YOU SERVE MEALS
Total Number of Meals Served This Month
Total Number of People Fed This Month
Total People (By Age Group) That Were Served Meals:
6 Years Old & Under
7-18 Years Old
19-54 Years Old
55+ Years Old
Total People (By Race) That Were Served Meals:
African American
Asian
Hispanic
White
American Indian
Other
Multiple
 
IF YOU DISTRIBUTE FOOD
Total Number of People Helped This Month
Total Number of Families Helped This Month
Total People (By Age Group) That Were Given Food:
6 Years Old & Under
7-18 Years Old
19-54 Years Old
55+ Years Old
Total People (By Race) That Were Given Food:
African American
Asian
Hispanic
White
American Indian
Other
Multiple
* Captcha: Please type the letters as they appear in the box below.
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Email Copy:  (send a copy of this submission to my inbox)