MT. ROSE CHURCH FOOD PANTRY

Please review the USDA Application. You may print for your records.

Household Application for USDA Foods/Solicitud domestic de los alimentos del USDA

COMPLETE MTRC PANTRY QUESTIONNAIRE

MTRC FOOD PANTRY FORM
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MTRC FOOD PANTRY
Questionnaire for MTRC Pantry applicants
Please provide the number of household members and ages

**Pantry Information:**

  • – **Operating Days:** Monday & Thursday

    – **Operating Hours:** 9:30 AM – 12:00 PM
    – **Response Time:** If the form is submitted after 5:00 PM, we will contact you on the next business day to schedule pick up.

    **Application Process:**

  • – We will plan our operating days based on the number of responses received.

    – After receiving your application, we will call to schedule your pick-up time/date.

    – Each individual will be allocated a 15-minute time slot for pick-up.

    – If you’re unable to make it within your allocated time, please let us know. However, we cannot hold food for longer than 24 hours, and we cannot reserve food for anyone.

    – Identification and a sign-in sheet will be required for pick-up, and only one person per household can pick up the box.

    **Information Required:**

  • **Section 2:**

    – Name

    – Phone Number

    – Number of people in your household and their ages

    **Section 3: (Choose one)**

    – If you receive government assistance, please check the applicable boxes.

    – If you do not receive any assistance, proceed to Section 5.

    **Section 5:**

    – Explain why you are in need of services (e.g., loss of income, etc.)

    **Frequency of Visits:**

    – Each household can visit once per week and once on the 4th Saturday of the month, totaling 2 visits per month.

    **Application Validity:**

    – The application is valid for one year.