GFA Pantry

Home
Mission & Vision
Media
Donate
Application
Application
Welcome
Please print, fill out and bring to us.

(Please Print)
First Name: _____________________M.I.___ Last Name: _________________________
Nickname: _________________________________Date of Birth: _________________________
Street Address: __________________________________________________________________
City: ________________________________Zip: ________________County: _________________
Phone Number: Home: Cell: __________________________________________________

(Circle One)
Source of Income: Social Security Disability SSI Child Support Wages Family Support
Amount of Income: (monthly) ____________ Do you receive SNAP Benefits? Yes or No
How many people in the household are employed? __________
(Circle One)
Gender: Female Male Transgender Do not identify as Male, Female, or Transgender
Ethnicity: Caucasian(white) African-American Asian Hispanic Marshallese Native American Middle Eastern Multiracial Other ___________
Education Completed: CollegeHigh School/GED Some College High School Incomplete

Employment: Full-Time Part-Time Unemployed Retired

Marital Status: Divorced Married Separated Single Widowed

Residential Status: Own Rent Homeless Transient At-Risk of Being Homeless

Would you like anyone to pick up food for you if you are unable? If so, please give their name(s):_____________

I, ______________ authorize ________________ to be my Authorized Representative and pick up my TEFAP products.

I, ____________________ understand misrepresentation of need, and the sale, exchange or misuse of commodities is prohibited and could result in a fine, imprisonment or both. I am aware my application may be selected for verification. I will cooperate should my application be selected. I am not receiving USDA foods from another source.

(Turn Over)
Please List All Household Members (excluding yourself):
First & Last Name Date of Birth Ethnicity Relationship Income Source & Amount

Mission & Vision

The Mission

The Mission of GFA Pantry is to be a
“Beacon of Hope to the Community“
without judgement to help people impacted
by food insecurity.

The Vision

The Vision of GFA Pantry is to lessen the
burden of food insecurity in our community.

Application

Welcome
Please print, fill out and bring to us.

Mission & Vision

The Mission

The Vision

Connect with us.

We'd love to hear from you. Fill out the form below to get started.

About

DISTRIBUTION Times

Follow Us

Application

WelcomePlease print, fill out and bring to us.

Mission & Vision

The Mission

The Vision

Connect with us.

We'd love to hear from you. Fill out the form below to get started.

About

DISTRIBUTION Times

Follow Us

Welcome
Please print, fill out and bring to us.