Partnership Eligibility
This form will determine if your organization is eligible for partnership
Organization Name:
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Name of the individual completing this form:
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First Name
Last Name
Email of the individual completing this form:
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example@example.com
Phone Number of the individual completing this form:
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Please enter a valid phone number.
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Organization Information
Is your organization located in Orange County California?
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Yes
No
Does your organization hold a non profit status, 501c3?
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Yes
No
What is your organizations EIN (501c3 number):
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Does your organization have a UEI number?
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Yes
No
What is your organizations UEI number?:
*
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Food Distribution Operations
Does your organization currently have a distribution?
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Yes
Currently not but planning on having one
How often does or will your organization distribute food? Please specify the frequency.
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What types of foods do you or will you plan to distribute? (select all that apply)
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Dry – canned goods, shelf stable items, etc.
Dry – non-refrigerated produce (apples, potatoes, etc.)
Refrigerated
Frozen
What is or will be your organization's distribution type: (select all that apply)
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Drive-thru:
Home delivery
Indoor permanent pantry space where clients come inside to shop/ receive their food
Outdoor or indoor pantry space where the distribution is set-up (with tables, etc.) just before the distribution, and set-down immediately after
Residential facility/ group home
Sit-down meal service
Walk-up: hot or cold meal/ snack pickup
Walk-up:
Who prepares the meals/ snacks ?
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Where are the meals/ snacks prepared?
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If serving residents. What challenges or barriers might residents face when trying to access food at other distribution locations? (If your organization is not a residential facility/ housing complex please respond N/A)
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Is your organization enrolled with the Health Department?
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Yes
No
How many distribution locations do you currently have or hope to have?
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Where does you organization's distribution take place?
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where is or will be your distribution on the “Client Choice Spectrum”?
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No choice; Each client receives the same predetermined items. Volunteers/staff handle the food and prepare bags or boxes for clients.
Limited choice; Clients can choose among a few types of boxes or receive a prepackaged box and can choose certain items from a table. Clients do not touch or handle the food directly.
Modified choice; Clients can select from general food types such as soup or cereal by selecting items from a menu or telling volunteers what items they want by pointing. Volunteers/staff then pack the box for clients.
Full choice; Clients may select from specific flavors or brands such as chicken noodle soup or Cheerios by shopping for food similar to a grocery store or ordering online for specific items. You might have limits on quantity to select; but clients may freely handle and select food themselves.
In what ways do you or will you create a dignified food distribution?
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What is or will be your organizations distribution plan? Please be specific, we will use this information to determine your organization's eligibility.
*
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Food Supply
Does your organization currently have a distribution?
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Yes
No
Do you have available funding to purchase food when you do not receive what you need from your food sources?
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Yes, money is budgeted for regular food purchasing
Yes, money is available periodically
Yes, but only in an emergency
No
Other
Where is your organization currently getting food from?
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