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COVID-19 Food Pantry Intake Form

United Way of Greater Newark exists to improve the lives of individuals, children and families within our footprint to strengthen the collective community.

This form is for food pantries and/or organizations that are currently operating in the Newark, NJ area.
 
*Once request is received please allow 3 - 5 business days to process your request*
Please submit questions to: shanell@rootsbridges.com
 
1.Information of organization completing this form.(Required.)
2.What demographic does your organization serve? (Multiple demographics can be listed in other)(Required.)
3.Do you serve daily or weekly?(Required.)
4.Number served according to response to Question #3?(Required.)
5.Do you require special dietary items? Please specify.(Required.)
6.Are you able to pick up? (Delivery will be handled case by case)(Required.)
7.Do you require bagged meals? (Each bag contains 21 meals) If yes, how many bags?(Required.)
8.Do you require unbagged for supplies? If yes, for how many people?(Required.)
9.Is your distribution ward specific? If so, which ward?(Required.)
10.Is your organization currently working with another agency to receive food supplies? Yes or No
If yes, please list all other agencies.(Required.)
Current Progress,
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