Monthly Reporting Forms

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

Agency Name*
Agency ID Number*
This Report Was Prepared By*
Phone*
Email*
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 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	Asian/China	Asian/Pacific Rim	Asian/Southeast

Black/African-American	Hispanic	Indian	Middle Eastern

Multi-Ethnic	Native American	Russian	White/American	White/E. Europian

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	Asian/China	Asian/Pacific Rim	Asian/Southeast

Black/African-American	Hispanic	Indian	Middle Eastern

Multi-Ethnic	Native American	Russian	White/American	White/E. Europian

List

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May 15, 2017

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March 28, 2017

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