CA State Employees Food Drive: Food Drive Credit Form

Thank you for participating in the CA State Employee Food Drive!! Whether you've donated food, money, or your time, we truly appreciate your dedication to your community.

Please fill out the information below and attach the related receipt(s).
NOTE: This form is to be filled out by each individual employee for any of the following credit:
Food Donation(s)
Monetary Donation(s)

Turkey Drive Donation

Run to Feed the Hungry Registration
Volunteer Hours

Deadline to submit food drive credit: Friday, January 21, 2022

Question Title

* 1. Agency/Department

Question Title

* 2. Donator Information

First Name

Last Name

Division/Office

Job Title

Email Address

Question Title

* 3. Food Donation(s)

Date of Donation

Food Bank

Food Item(s)

Pounds of Food

Question Title

* 4. Food Donation Attachment

Please attached your food donation receipt

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 5. Monetary Donation(s) - Cash, Check, or Online

Date of Donation

Food Bank

Cash, Check, or Online

Amount

Question Title

* 6. Monetary Donation(s) - Monthly State Program

Month of Paycheck

Food Bank

Amount

Question Title

* 7. Monetary Donation Attachment

Please attached your donation receipt

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 8. Turkey Drive Donation(s)

# of Turkeys

Total Weight

Question Title

* 9. Turkey Drive Donation Attachment

Please attached your donation receipt

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 10. Run to Feed the Hungry Registration

Registration Confirmation Date

Number of Participants

Registration Confirmation Number(s)

Question Title

* 11. Run to Feed the Hungry Confirmation Attachment

Please attached your confirmation email or receipt for your Run to Feed the Hungry registration.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 12. Volunteer Work

Date of Volunteer Work

Food Bank

Activity

Hours Worked

Question Title

* 13. Please enter your full name and today's date as your digital signature to confirm your participation credit for the 2021 CA State Employee Food Drive:

Signature (full name)

Today's Date