2018 PARTNERSHIP APPLICATION
DOCUMENTS TO ATTACH TO APPLICATION
Use the following checklist to confirm your application is complete. Please contact us if we can answer any questions for you, email or call 616.784.3250
All supporting forms are available on our website, FeedWM.org
☐$100 Non-refundable application fee paid with check from the 501(c)(3), church or sponsor.
☐Complete Partnership Application, (FeedWM.org/agencies/partner-application)
☐Signed Agency Agreement, (FeedWM.org/agencies/agency-agreement )
☐Initialed Policies and Procedures (2 pages, FeedWM.org/agencies/policies )
☐Proof of tax exempt status (one of the following)
- Copy of IRS/US Dept. of Treasury letter of Determination stating your 501(c)(3) tax exempt status
- Proof of denomination affiliation
- Proof of tribal affiliation
- Letter containing the information necessary to meet the IRS criteria specified in Publication 1828. Download worksheet, FeedWM.org/agencies/14pt-letter
☒Annual Budget
☐ Sample outreach materials (how people learn about your programs)
☒List of Board of Directors/ Governing Board
☐In the rare circumstance that a sponsorship is needed, the sponsoring organization must provide a letter signed by the executive or board president indicating theirorganization assumes legal and financial responsibility for your program.
Meal sites must include:
☐Health Department Inspection certificate.
☐Manager Level Servsafe if meal site open to the public.
Send copies (keep your originals) along with agency check for $100, to:
Partner Applications
Feeding America West Michigan
864 West River Center Drive
Comstock Park, MI 49321-8955
Application packets may also be emailed to or faxed to 616-784-3255
Legal Organization Name: Click here to enter text.
Billing Address:
Click here to enter text.
Executive Director: Click here to enter text.Phone Number: Click here to enter text.
Program Name: Click here to enter text.
Address of program: Click here to enter text.
Address where food will be stored:Click here to enter text.
Primary Contact
Name: Click here to enter text.Title: Click here to enter text.
Office Phone:Click here to enter text.Email: Click here to enter text.
Cell Phone for driver to use if delayed: Click here to enter text.
Secondary Contact
Name: Click here to enter text.Title: Click here to enter text.
Office Phone:Click here to enter text.Email: Click here to enter text.
Cell Phone for driver to use if delayed: Click here to enter text.
Accounts Payable Contact
Name: Click here to enter text.Title: Click here to enter text.
Office Phone:Click here to enter text.Email: Click here to enter text.
A. Program Description
1. Briefly describe your program or services:
Click here to enter text.
2. When did you begin these services?
Click here to enter text.
3. Geographic area or population served:
Click here to enter text.
4. Does your agency provide other services besides food?
Click here to enter text.
5. Days and hours of service:
Click here to enter text.
6. Are your hours posted on the outside of your building?Choose an item.
7. List organizations you are currently working with
Click here to enter text.
8. Check programs desiring food bank support:
☐Fixed site pantry (emergency food/grocery programs)
☐Mobile pantry
☐ On-Site Meal Program (prepared meals –i.e. senior meals, soup kitchens, shelters)
☐ Residential facility/group home
☐ Large-scale distribution host (large distribution at least once a month, no open pantry)
☐ Homebound Meal or Grocery Delivery Service
☐ After school, sack supper or summer program
☐Other, specify: Click here to enter text.
C. Who do you serve?
1. Are your program(s) open to anyone in need? Please describe eligibility requirements.
Click here to enter text.
2. Specify Protected Population(s) served, if applicable:
☐ Homeless
☐ Elderly
☐ Residential
☐ Youth
☐ Veterans
☐ Refugee
☐ Migrant
☐ Sexual Assault Victims
☐ Other: ______
3. How are people referred to your program?
Click here to enter text.
4. How often can someone receive services?
Click here to enter text.
5. How many meals or days of food are provided?
Click here to enter text.
6. Average number of households served per month:
Click here to enter text.
7. Average number of individuals served per month:
Click here to enter text.
D. Paying for the food
In addition to the detailed budget you provide, please answer these financial questions:
- If there a fee for your program, please describe what it is used for.
Click here to enter text.
- If you are reimbursed for services, please list by whom and why.
Click here to enter text.
- If you encourage a contribution or suggest a price for the food received, please describe how the amount is determined, how the transaction occurs and why is it encouraged.
Click here to enter text.
E. Food, Storage and Transportation
1. Sources of Food (estimate percentages)
Retail purchase______%
Food Donations______%
Food bank ______%
Other: ______%
Total: 100%
2. Describe your food storage area. Include information about refrigerators and freezers.
Click here to enter text.
3. How will you transport cold and/or frozen food?
Click here to enter text.
4. List specific food needed for your program:
Click here to enter text.
5. Is food stored at other sites? Choose an item.
6. List individuals that may place orders and/or pick up food for your agency. You may update this list at any time by emailing or calling our office:
Name: Click here to enter text.Title: Click here to enter text.
Cell Phone:Click here to enter text.Email: Click here to enter text.
Name: Click here to enter text.Title: Click here to enter text.
Cell Phone:Click here to enter text.Email: Click here to enter text.
Name: Click here to enter text.Title: Click here to enter text.
Cell Phone:Click here to enter text.Email: Click here to enter text.