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

Question Title

* 1. Information of organization completing this form.

Name

Company

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. What demographic does your organization serve? (Multiple demographics can be listed in other)

Seniors

Shelters

Families

Individuals

Housing complex

Other (Select this if there are multiple demographics. Please list)

Question Title

* 3. Do you serve daily or weekly?

Daily

Weekly

Other (please specify)

Question Title

* 4. Number served according to response to Question #3?

Question Title

* 5. Do you require special dietary items? Please specify.

Yes

Question Title

* 6. Are you able to pick up? (Delivery will be handled case by case)

Yes

Question Title

* 7. Do you require bagged meals? (Each bag contains 21 meals) If yes, how many bags?

Question Title

* 8. Do you require unbagged for supplies? If yes, for how many people?

Question Title

* 9. Is your distribution ward specific? If so, which ward?

Not ward specific

North ward

South ward

East ward (Ironbound)

West ward

Central ward

COVID-19 Food Pantry Intake Form

Question Title

* 1. Information of organization completing this form.

Question Title

* 2. What demographic does your organization serve? (Multiple demographics can be listed in other)

Question Title

* 3. Do you serve daily or weekly?

Question Title

* 4. Number served according to response to Question #3?

Question Title

* 5. Do you require special dietary items? Please specify.

Question Title

* 6. Are you able to pick up? (Delivery will be handled case by case)

Question Title

* 7. Do you require bagged meals? (Each bag contains 21 meals) If yes, how many bags?

Question Title

* 8. Do you require unbagged for supplies? If yes, for how many people?

Question Title

* 9. Is your distribution ward specific? If so, which ward?

Question Title

* 10. Is your organization currently working with another agency to receive food supplies? Yes or NoIf yes, please list all other agencies.

* 10. Is your organization currently working with another agency to receive food supplies? Yes or No
If yes, please list all other agencies.