Monthly Reporting Form Please fill out the form below to report your monthly food distribution. About YouAgency Name* Agency ID Number* This Report Was Prepared By* Phone*Email* This report reflects activity in the month of:Month*Please Select One123456789101112Year*Please Select One202120222023 If You Distribute Food Please fill out this section: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 - DIS6 Years Old & UnderPlease enter a number from 0 to 1000.7-18 Years Old - DIS7-18 Years OldPlease enter a number greater than or equal to 0.19-54 Years Old - DIS19-54 Years OldPlease enter a number greater than or equal to 0.55+ Years Old - DIS55+ Years OldPlease enter a number greater than or equal to 0.Your Total People Served (By Age)Please ensure this number matches the total number of people helped that you reported above.Total People (By Race) That Were Given Food:Black or African American - DISBlack or African AmericanPlease enter a number greater than or equal to 0.Asian - DISAsianPlease enter a number greater than or equal to 0.Hispanic or Latino - DISHispanic or LatinoPlease enter a number greater than or equal to 0.White - DISWhitePlease enter a number greater than or equal to 0.American Indian or Alaskan Native - DISAmerican Indian or Alaskan NativePlease enter a number greater than or equal to 0.Native Hawaiian or Pacific Islander - DISNative Hawaiian or Pacific Islander Please enter a number greater than or equal to 0.Middle Eastern or North African - DISMiddle Eastern or North African Please enter a number greater than or equal to 0.Multi-Racial/Ethnic - DISMulti-Racial/Ethnic Please enter a number greater than or equal to 0.Client Prefers Not to Disclose - DISClient Prefers Not to DisclosePlease enter a number greater than or equal to 0.Other - DISOtherPlease enter a number greater than or equal to 0.Your Total People Served (By Race)Please ensure this number matches the total number of people helped that you reported above. If You Serve Meals - Residential Please fill out this section (scroll down for community meals): TOTAL NUMBER OF MEALS SERVED THIS MONTH TOTAL NUMBER OF UNDUPLICATED PEOPLE FED THIS MONTH TOTAL PEOPLE (BY AGE GROUP) THAT WERE GIVEN FOOD:6 Years Old & Under - RES6 Years Old & UnderPlease enter a number greater than or equal to 0.7-18 Years Old - RES7-18 Years OldPlease enter a number greater than or equal to 0.19-54 Years Old - RES19-54 Years OldPlease enter a number greater than or equal to 0.55+ Years Old - RES55+ Years OldPlease enter a number greater than or equal to 0.YOUR TOTAL PEOPLE SERVED (By Age)Please ensure this number matches the total number of people helped that you reported above.TOTAL PEOPLE (BY RACE) THAT WERE GIVEN FOOD:Black or African American - RESBlack or African AmericanPlease enter a number greater than or equal to 0.Asian - RESAsianPlease enter a number greater than or equal to 0.Hispanic or Latino - RESHispanic or LatinoPlease enter a number greater than or equal to 0.White - RESWhitePlease enter a number greater than or equal to 0.American Indian or Alaskan Native - RESAmerican Indian or Alaskan NativePlease enter a number greater than or equal to 0.Native Hawaiian or Pacific Islander - RESNative Hawaiian or Pacific Islander Please enter a number greater than or equal to 0.Middle Eastern or North African - RESMiddle Eastern or North African Please enter a number greater than or equal to 0.Multi-Racial/Ethnic - RESMulti-Racial/Ethnic Please enter a number greater than or equal to 0.Client Prefers Not to Disclose - RESClient Prefers Not to DisclosePlease enter a number greater than or equal to 0.Other - RESOtherPlease enter a number greater than or equal to 0.YOUR TOTAL PEOPLE SERVED (BY RACE)Please ensure this number matches the total number of people helped that you reported above. If You Serve Meals - Community Please fill out this section: TOTAL NUMBER OF MEALS SERVED THIS MONTH NUMBER OF DAYS MEALS WERE SERVED THIS MONTH TOTAL PEOPLE (BY AGE GROUP) THAT WERE GIVEN FOOD:6 Years Old & Under - COM6 Years Old & UnderPlease enter a number greater than or equal to 0.7-18 Years Old - COM7-18 Years OldPlease enter a number greater than or equal to 0.19-54 Years Old - COM19-54 Years OldPlease enter a number greater than or equal to 0.55+ Years Old - COM55+ Years OldPlease enter a number greater than or equal to 0.Your Total People Served (By Age)Please ensure this number matches the total number of people helped that you reported above.Total People (By Race) That Were Given Food:Black or African American - COMBlack or African AmericanPlease enter a number greater than or equal to 0.Asian - COMAsianPlease enter a number greater than or equal to 0.Hispanic or Latino - COMHispanic or LatinoPlease enter a number greater than or equal to 0.White - COMWhitePlease enter a number greater than or equal to 0.American Indian or Alaskan Native - COMAmerican Indian or Alaskan NativePlease enter a number greater than or equal to 0.Native Hawaiian or Pacific Islander - COMNative Hawaiian or Pacific Islander Please enter a number greater than or equal to 0.Middle Eastern or North African - COMMiddle Eastern or North African Please enter a number greater than or equal to 0.Multi-Racial/Ethnic - COMMulti-Racial/Ethnic Please enter a number greater than or equal to 0.Client Prefers Not to Disclose - COMClient Prefers Not to DiscloseOther - COMOtherYour Total People Served (By Race)Please ensure this number matches the total number of people helped that you reported above. 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