Directory Information/Update Form

Organization Name: Organization Contact:
Organization Phone: Site Phone:
Organization Mailing Address: Site Street Address:
CityStateZip Code
CityStateZip Code
Please choose preferred address to be listed in the directory:
Mailing Address Site Address

Organization Email Address:

 Organization Website URL:
Geographic Area Served: Hours of Operation:

Organization Type: (Check all that apply)
Food Pantry Congregate Meal Program
Soup Kitchen Shelter
Meal Delivery Program Other (Please Specify):
Food Distribution Recipients: (Check all that apply)
Non-Profit Organizations Elderly
Families and Children All Families
Homeless Anyone in Need
Disabled Pregnant Women
TANF* Other (Please Specify):
*Temporary Assistance for Needy Families