Nourish 282 Food Assistance Program June 2022 - May 2023

Enrollment Form

The Nourish 282 Food Assistance Program provides monthly support to families who live within, or attend, the St. Anthony/New Brighton School District (MN ISD 282) that could use help providing food stability in their household. Nourish 282 provides grocery store gift cards to families whose students are enrolled. Families will receive one $50 gift card per month, per child enrolled in this program, with a family cap of $250 per month. Example: 1 student = $50 gift card, 3 students = $150 gift card, 5+ students = $250 gift card each month.

All families must re-enroll annually.

If you are currently enrolled and receiving assistance, please fill out the form below. This annual enrollment helps us ensure we have current information on file and are accounting for all new family members.

New to the program? Please fill out the form below.

Gift cards are distributed on the second Thursday of each month, at 2708 33rd Ave NE, St Anthony (Faith United Methodist Church). Delivery is available for those without transportation, this must be arranged prior to the pick up date. A representative from Nourish 282 will contact you via email each month with reminders about pick up and an online shopping form for our pantry. Current enrollment period is for June 2022 through May 2023.

Please know that we take the privacy of our clients and their families very seriously. The information you provide here will be held confidentially.

Contact Julie Pierce directly (info@nourish282.com) with questions.

Question Title

* 1. Parent/Care Giver Name(s)

Parent/Care Giver Name(s) *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Please list all children in your household.
Children 1 year and younger, please list 'grade' as infant
Children ages 1-5 years, please list 'grade' as pre-k

Child 1 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 2 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 3 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 4 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 5 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 6 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 7 (include full name, date of birth, grade for '22/23 school year, and current School)

Child 8 (include full name, date of birth, grade for '22/23 school year, and current School)

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* 3. Would you prefer your gift cards be from Aldi or Cub?

Aldi

Cub

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* 4. How many people reside in your household? (adults and children)

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* 5. Which of the following languages would you prefer to receive written communication in? (Please select all that apply, we are working on translation services.)

Amharic

English

French

Japanese

Spanish

Tibetan

Other (please specify)

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* 6. By answering these next 2 questions about race and ethnicity, it allows us to provide clear data for funding requests.

What global ancestry would best describe your child(ren)? Check all that apply.

Africa

Asia

Australia/Oceana

Europe

North America

South America

Other (please specify)

Question Title

* 7. Which categories best describe your child(ren). Please select all that apply.

African American

Indigenous, Indigenous American or Alaska Native

Black

East Asian

Hispanic or Latino

Native Hawaiian or Pacific Islander

South Asian

Southeast Asian

White

Multiethnic or Multiracial

Prefer not to answer

Other (please specify)

Question Title

* 8. Please answer this question how it pertains to you today. This is always changeable.

I am able to pick up our monthly gift card and pantry extras each month.

I will require delivery of our gift card and pantry extras each month.

This will likely fluctuate from month to month, I will let you know each month.

Question Title

* 9. Each week three chefs prepare and donate meals to Nourish 282. We provide these meals to anyone enrolled in our food assistance program. Meals feed 4-5 people, but individual meals are available by request.

Meals are delivered on Wednesdays between 5:00 - 7:00 pm. An email reminder goes out 3-4 days prior and someone must be home to receive the meal. We deliver only to the St. Anthony/New Brighton/NE Minneapolis area. Pick up can be arranged, if needed.

Are you interested in receiving a prepared family meal?

Yes

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* 10. Each summer a local gardener provides fresh produce weekly for those interested. Produce is typically available June - September. By checking 'yes', you will receive emails about this program.

I am interested in your Summer Produce program.

Yes

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* 11. Sometimes we provide additional support during school breaks. Please let us know if there is a time of year, specific holiday, or other special religious or cultural event that additional support would be helpful. An example could be added financial assistance or a family meal.

Please answer as specifically as you are able. If we have questions, we will follow up.

Question Title

* 12. Lastly, we believe in community and are proud of our partnerships with local civic groups. The Kiwanis of St. Anthony is a civic group dedicated to enriching the lives of students in our community. If you are new to the community (within a year or two) would you like someone from the Kiwanis to reach out to you and provide a Welcome Kit? Their Welcome Kit comes with valuable information regarding community resources.

Yes, please share my name, address, and email with the Kiwanis of St Anthony.
By checking this box, you are consenting to have the above information shared with Kiwanis of St. Anthony.

N/A - I am not new to the community

Nourish 282 Food Assistance Program June 2022 - May 2023

Enrollment Form

Question Title

* 1. Parent/Care Giver Name(s)

Question Title

* 2. Please list all children in your household.Children 1 year and younger, please list 'grade' as infantChildren ages 1-5 years, please list 'grade' as pre-k

Question Title

* 3. Would you prefer your gift cards be from Aldi or Cub?

Question Title

* 4. How many people reside in your household? (adults and children)

Question Title

* 5. Which of the following languages would you prefer to receive written communication in? (Please select all that apply, we are working on translation services.)

Question Title

* 6. By answering these next 2 questions about race and ethnicity, it allows us to provide clear data for funding requests. What global ancestry would best describe your child(ren)? Check all that apply.

Question Title

* 7. Which categories best describe your child(ren). Please select all that apply.

Question Title

* 8. Please answer this question how it pertains to you today. This is always changeable.

Question Title

Question Title

* 10. Each summer a local gardener provides fresh produce weekly for those interested. Produce is typically available June - September. By checking 'yes', you will receive emails about this program. I am interested in your Summer Produce program.

Question Title

Question Title

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* 13. Please share any further information about you and your family that you feel would help us serve you better. Thank you!

* 2. Please list all children in your household.
Children 1 year and younger, please list 'grade' as infant
Children ages 1-5 years, please list 'grade' as pre-k

* 6. By answering these next 2 questions about race and ethnicity, it allows us to provide clear data for funding requests.

What global ancestry would best describe your child(ren)? Check all that apply.

* 10. Each summer a local gardener provides fresh produce weekly for those interested. Produce is typically available June - September. By checking 'yes', you will receive emails about this program.

I am interested in your Summer Produce program.