Please use this form to refer families to the City of Shoreline in order to receive Safeway grocery vouchers. Email foodvoucher@shorelinewa.gov or call (206) 801-2740 if you have any questions. 

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* 1. Referral source; please enter your contact information

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* 2. Family Information

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* 3. Family size

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* 4. Number of children 18 or younger

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* 5. Language(s) spoken in the home

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* 6. This family...

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* 7. This family receives cash, food, healthcare, housing, or childcare assistance from the State of Washington, such as (check all that apply):

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* 8. A member of this family is a displaced worker due to COVID-19 AND

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