River Cities Harvest

Recipient Agency Application

1.Name of Agency: ______

2. Address: Street ______

City ______State ______Zip ______

3. Agency phone number: (day) ______(evening) ______

4. Normal operating hours for agency: ______

______

5. Can agency be available at other times? Evenings yes ( ) no ( ) Weekends yes ( ) no ( )

6. Person(s) to contact at location during normal operating hours to discuss pickup and/or receipt of food.

  1. ______
  2. ______

7. Information on persons to contact in evenings and on weekends.

Evening contact: Name ______Phone ______

Weekend contact: Name ______Phone ______

8. Please tell us about your funding. What is your annual budget and where do those funds come from?

______

9. How does the agency serve the community? How many clients? Please be specific about the number of meals the agency serves each day/week/month and tell us when the meal is served or when the pantry is open and how the food is distributed.

______

10. How much food does the agency need each week or month?

______

11. What types of food does the agency need regularly?

______

12. What types of food does the agency need on occasion?

______

13. What types of food does the agency never need?

______

14. Can the agency handle perishable foods? Yes ( ) No ( )

15. Give a description of refrigerated storage.

( ) None

( )Small- one refrigerator or cooler

( )Medium- multiple units. Number of units-______

( )Large- storage of reasonable amounts of food is not a problem.

16. Give a description of freezer capacity.

( ) None

( ) Small- household type freezer

( ) Medium- multiple units. Number of units- ______

( ) Large- storage of reasonable amounts of food is not a problem

17. Does the agency have an available truck or van and driver to pick-up either produce, perishable or canned foods?

1. Weekdays Yes ( ) No ( )

2. Evenings Yes ( ) No ( )

3. Weekends Yes ( ) No ( )

18. Is the agency willing to provide a volunteer to do regular pick-ups from grocery stores or restaurants, with the donated food going to your agency? Yes ( ) No ( )

Please provide the names of these volunteers and how to reach them. ______

19. Does the agency have volunteers that would be able to help RCH in other special projects throughout the year? Yes ( ) No ( ) Fundraisers, food drives, special events, garden projects. Please list volunteer names and contact information.

______

20. Agency comments:

______

River Cities Harvest recommends that all agencies visit the Facing Hunger Food Bank website at facinghunger.org to fill out their application and register with their organization.

Return completed form to:

River Cities Harvest
P.O. Box 2136
Ashland, KY 41105