1.What is your name and your position title?

2.What is the best email address to connect with you?

3.What is the name of your organization?

4.What is the zip code of your organization? 

5.Please explain the services you provide and the population your organization serves. 

6.How many people does your organization serve every week?

7.Do you work with a food bank? If so, which food bank?

8.If you are working with a local food bank, what type of services do you provide and how often do you provide them?

9.If you are working with a food bank, do they meet your needs? Please explain. 

10.What type of food do you want to receive from Food Dignity®?

11.Do you have industrial freezers and coolers to store food at your organization? If no, do you have space for a freezer and/or cooler?

12.Is there anything else you want us to know about your organization?