iFeed Food Program Application

Please fill out this form and click submit.
Questions or concerns? contact us at: (323)-589-1922

Agency Information

Agency Name

Type of Agency

Please select all that apply.

Food Pantry Church Senior Shelter Veteran Rehab Government Other

If other, please specify.

Agency Address

Site Phone

Director/Senior Pastor Name

Website Address

Social Media

Program Information

Language of Program

Please select one option.

English Spanish Arabic Japanese Russian Portuguese German Other

If other, please specify.

Distribution Address (if same as above, please skip).

Food Distribution Coordinator

Mobile Phone

Associate Person

Alternative Phone

Primary Email

This address will receive a confirmation email

Alternative Email

Questions

How many families do you serve on a weekly basis?

Is your organization 501(c)(3) designated?

Please select one option.

Yes No Other

If other, please specify.

Attach 501(c)(3)

Upload (8MB)

Do you have an insurance of liability? (This will not affect eligibility).

Please select one option.

Yes No

Attach Insurance of liability here.

Upload (8MB)

Do you feed the homeless?

Please select one option.

Yes No

Do you have an active Youth/Volunteer Program?

Please select one option.

Yes No

How often are the distributions?

Please select one option.

Daily Weekly Bi-weekly Monthly Bi-monthly Other

If other, please specify.

What day(s) of the week do you distribute?

Please select all that apply.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Do you provide overnight accomodations?

Please select one option.

Yes No

Do you sell product?

Please select one option.

Yes No

Do you charge participants for food?

Please select one option.

Yes No

In what ways do you help the community?

Acknowledgement of Applicant

We at Helping Hands Society of Los Angeles help your agency to aid others in your community. In order for us to do that however, we need to keep our donors informed on what we do by providing pictures of distributions periodically to show them the difference they are making in donating us products. Upon E-signature, your agency agrees to provide all pictures of distributions when requested, and on-site visits to your facility.

Name

Date

Description

Please fill out this form and click submit.
Questions or concerns? contact us at: (323)-589-1922

iFeed Food Program Application

Description

Please Fix the Following