Partner Agency Screening

The Process

Complete this form as a preliminary step of the Partner Agency application process. Please be sure to attach the requested documents.

The following documents will be requested:

501(c)(3) IRS Letter of Determination, updated with current agency/organization address and information
- If the food program is not the holder of the 501(c)(3) status, a signed letter from the organization holding the 501(c)(3) confirming they are sponsoring the food program
Certified Kitchen License
Food program mission statement
Food program budget
A list of the Board Members/Advisory Board members and their contact information

Screening forms will be reviewed on a monthly basis. Please allow proper time for review before we contact you in regards to your status.

Based on your screening, you may be invited to complete a full application, at which point the NEIFB will invoice you for the $125 non-refundable application fee. Personal checks and cash are not accepted. Payment MUST be a check from the sponsoring organization or named program. Applications will not be reviewed until the application fee has been received.

Agency applications will be reviewed on a biannual basis as detailed below. If you are invited to complete a full application, the month in which the completed application and application fee is received will determine when the application review, approval and training will take place.

For example:

The Screening Form is completed July 12 with documents and the Application submitted August 3. review, approval and training will be in September with the first partnership month as October.
The Screening Form completed August 3 with documents and the Application submitted on September 1. The review, approval and training will be in March.

We will contact you once the review and approval process have been completed.

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* 1. Initial below to confirm your acknowledgement of this process and timeline.

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* 2. Please provide the following information about you:

Your First and Last Name

Your Title/Role in relation to the Food Program

Preferred Email Address

Preferred Phone Number

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* 3. Please provide the following information about the sponsoring organization:

Agency/Organization Name

Agency/Organization Address

Agency/Organization City/Town

Agency/Organization ZIP/Postal Code

Agency/Organization County of Operation

Agency/Organization Email Address

Agency/Organization Phone Number

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* 4. Does the Food Program have the same name, address and contact information as the Sponsoring Organization?

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* 5. If different from the Agency/Organization, please provide the information for the Food Program.

Food Program Name

Food Program Address

Food Program City/Town

Food Program ZIP/Postal Code

Food Program County of Operation

Food Program Email Address

Food Program Phone Number

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* 6. What type of food program is this? Select all that apply.

Food Pantry

School Pantry

Community Meal

Senior meal

Daycare

Youth Program

Rehab

Group Home

Emergency Shelter

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* 7. Is the food program your main program and purpose of why your organization was formed?

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* 8. Why did you begin your food program?

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* 9. How long has the food program been operating?

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* 10. Are you participating in the Child and Adult Care Food Program (CACFP)?

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* 11. How do clients use food provided by your food program? Select all that apply.

Grocery products are used for personal consumption on site

Grocery products are used for personal consumption off site

Prepared meal is consumed in a congregate meal setting

Prepared meal is distributed for off site consumption (To-go prepared meals)

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* 12. Are 51% or more of those you serve food insecure?

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* 13. How many housesholds do you serve each month?

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* 14. Please describe the process the food program uses to determine that the majority of the people you serve is food insecure.

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* 15. Does your food program or agency have a 501c3 status? If you are unsure, please visit the IRS.gov website https://apps.irs.gov/app/eos/ to check.

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* 16. What is the food program or sponsoring organization's 501c3 number?

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* 17. You are required to send the 501(c)(3) IRS Letter of Determination. It must be updated with current agency/organization address and information. If the food program is not the holder of the 501(c)(3) status, a signed letter from the organization holding the 501(c)(3) confirming they are sponsoring the food program is required. ATTACH DOCUMENT.

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

Choose File

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* 18. Does your agency have an executive director, president, or other designated leader position?

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* 19. Does your agency have a formal Board of Directors/Advisory Board?

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* 20. Please provide a list of the Board Members/Advisory Board and the members' contact information

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* 21. Please attach the list of your Board Members/Advisory Council and their contact information. ATTACH DOCUMENT.

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

Choose File

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* 22. If this is a congregate meal (serving meals more than once a week), do you have a licensed kitchen?

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* 23. Please attach your Certified Kitchen License. ATTACH DOCUMENT.

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

Choose File

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* 24. Do you have a food program mission statement?

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* 25. Attach the copy of the food program's mission statement. ATTACH DOCUMENT.

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

Choose File

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* 26. Do you have a food program budget?

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* 27. Please attach the full food program budget to this Screening form. ATTACH DOCUMENT.

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

Choose File

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* 28. Below you will see a table of Partner Agency Requirements. Do you agree that the meal program meets the requirements of one of the categories? Indicate which type.

School Pantry (ONLY for schools)

Core Pantry

Strategic Pantry

I am not a Pantry

I am a Pantry, but do not meet the requirements currently and will not be able to obtain them

I am a Pantry, but do not meet the requirements currently but am able to obtain them

Partner Agency Screening

The Process

Question Title

* 1. Initial below to confirm your acknowledgement of this process and timeline.

Question Title

* 2. Please provide the following information about you:

Question Title

* 3. Please provide the following information about the sponsoring organization:

Question Title

* 4. Does the Food Program have the same name, address and contact information as the Sponsoring Organization?

Question Title

* 5. If different from the Agency/Organization, please provide the information for the Food Program.

Question Title

* 6. What type of food program is this? Select all that apply.

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* 7. Is the food program your main program and purpose of why your organization was formed?

Question Title

* 8. Why did you begin your food program?

Question Title

* 9. How long has the food program been operating?

Question Title

* 10. Are you participating in the Child and Adult Care Food Program (CACFP)?

Question Title

* 11. How do clients use food provided by your food program? Select all that apply.

Question Title

* 12. Are 51% or more of those you serve food insecure?

Question Title

* 13. How many housesholds do you serve each month?

Question Title

* 14. Please describe the process the food program uses to determine that the majority of the people you serve is food insecure.

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* 15. Does your food program or agency have a 501c3 status? If you are unsure, please visit the IRS.gov website https://apps.irs.gov/app/eos/ to check.

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* 16. What is the food program or sponsoring organization's 501c3 number?

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* 18. Does your agency have an executive director, president, or other designated leader position?

Question Title

* 19. Does your agency have a formal Board of Directors/Advisory Board?

Question Title

* 20. Please provide a list of the Board Members/Advisory Board and the members' contact information

Question Title

* 21. Please attach the list of your Board Members/Advisory Council and their contact information. ATTACH DOCUMENT.

Question Title

* 22. If this is a congregate meal (serving meals more than once a week), do you have a licensed kitchen?

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* 23. Please attach your Certified Kitchen License. ATTACH DOCUMENT.

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* 24. Do you have a food program mission statement?

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* 25. Attach the copy of the food program's mission statement. ATTACH DOCUMENT.

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* 26. Do you have a food program budget?

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* 27. Please attach the full food program budget to this Screening form. ATTACH DOCUMENT.

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* 28. Below you will see a table of Partner Agency Requirements. Do you agree that the meal program meets the requirements of one of the categories? Indicate which type.

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* 29. Is there anything else you'd like to share with us in regards to your interest in becoming a partner with the NEIFB?