1 Organization & Contact Information2 Food Donation & Compliance I am a:*Food BusinessNonprofitOrganization InformationOrganization Name*What is your organization type (choose one)Affordable Housing ComplexChurchCommunity CenterFamily Resource CenterFood Pantry/KitchenHousing ComplexResidential HomeSchoolShelterPhysical Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Distribution Address Same as Physical Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Contact InformationPrimary Contact Name* First Last Primary Contact Position*Primary Contact Email* Enter Email Confirm Email Primary Contact Phone*Primary Contact Mobile/Other Phone Add a Secondary Contact Secondary Contact InformationSecondary Contact Name First Last Secondary Contact PositionSecondary Contact Email Enter Email Confirm Email Secondary Contact PhoneSecondary Contact Mobile/Other PhoneFor Nonprofits OnlyAre you a current Foodbank of SBC partner?YesNoWebsite How many unique individuals do you serve?What is your primary population served? (choose one)All populations18 years old and underHomebound individualsIndigenous non-native English speakersLow-incomeMentally IllNon-native English speakersPersons with a mental health disabilityPersons with disabilitiesSenior CitizensUndocumented immigrantsUnshelteredVeteransWhat is/are your secondary population(s) served? (select all that apply) Select All 18 years old and under Homebound individuals Indigenous non-native English speakers Low-income Mentally Ill Non-native English speakers Persons with a mental health disability Persons with disabilities Senior Citizens Undocumented immigrants Unsheltered Veterans Public Facing InformationWhat food services do you provide? (select all that apply) Select All congregate meal site food pantry (including perishables) food pantry (non-perishables only) Foodbank of SBC distribution site home delivery prepared meal meal service for program participants only What are your distribution days and times?add up to 10 rows1 Day2 Opening time3 Closing time Public PhonePublic Email Are there eligibility requirements for participation?YesNoIf Yes, please share the requirements.What languages are services available in? Select All English Español Mixteco Other / Otro Other languageIs there anything else you would like to share with potential recipients?Are there COVID-19 specific notes you would like to share with potential recipients?What other services do you offer? (i.e. Cal Fresh application support)Do you have other items available to the public? (i.e. clothing, diapers, household items, etc.)Facebook page(s) or groupsInstagram handleTwitter handle Food Donation/Compliance InformationDo you know that food donation is tax deductible?YesNoAre you currently donating your surplus food?YesNoWhat organization(s) are you currently donating to?Are you tracking quantities?YesNoIf no, do you have the resources to start tracking quantities?YesNoHow often do you donate?What types of food are you donating?Do you like your current donation process?YesNoIf yes, what do you like about it?If no, what could be improved?How can we help you develop a food donation process?Do you have any other information to share regarding your food waste management?Would you like to schedule a call to discuss this information in more detail?YesNoIf yes, can you please share your availability for a call?Would you like me to connect you with your local solid waste representative to discuss more about what your options for inedible food scraps are?YesNoCapacity and NeedsDo you currently collect or receive any donations of rescued food?YesNoWhat business(es) are you currently receiving donations from?Are you tracking quantities?YesNoIf no, do you have the resources to start tracking quantities?YesNoDo you like your current donation process?YesNoIf no, what could be improved?If yes, what do you like about it?Would you be interested in receiving donations of rescued foods?YesNoWhat types of food? (select all that apply) Select All Dairy Meat (uncooked) Produce (fruits and vegetables) Dry Foods (can, bottle, packaged) Catering/Restaurant/Cafeteria/Prepared Bakery/Dessert/Bread What is your refrigeration capacity?What sort of cooking/food preparation equipment do you have available? (select all that apply) Select All Refrigerator Freezer Walk-in Refrigerator Walk-in Freezer Oven Stove Other If Other, what sort of cooking/food preparation equipmentWhat would help enable you to serve your participants more efficiently and effectively? (i.e. specific equipment, transportation)Is there anything else you would like to share?EmailThis field is for validation purposes and should be left unchanged.
