Partnership Inquiry
Contact Information
Enter the contact information of the individual we should follow up with representing the organization
Contact First Name
Contact Last Name
Contact Suffix
Contact Work Address
Work Street
Work City
Work State/Province
Work Zip
Contact Work Phone
Contact Email Address
Organization Role
Please select...
Executive/Leadership
Food Distribution main contact
Compliance
Other
Organization Information
Organization Name
Distribution Location/Address
:
Distribution Street
Distribution City
Distribution State/Province
Distribution Zip
Main Phone Number
Web Site
Comments
Program Information
Tell us how you would like to partner with Second Harvest.
Overall Goal/Need for Food
Please select...
New Partner/Organization wants support for their food program
New Partner/Organization wants to start a food program
New Partner/Organization wants to support or lead a distribution operated by Second Harvest
Existing Partner interested in doing more
Target Population – Who will you serve?
Please select...
Open to the community
Specific/own population – prefer to serve our own constituents
Are you a Non-profit with a 501c3?
Yes
No
Organization Type
Please select...
Other
Government
Nonprofit
Foundation
Community Center
Faith Based
School
What infrastructure set-up do you currently have?
Please select...
None
Place to store food
Cold storage
Location for distribution
Hold "CTRL" to select multiple requirements at once
Are you currently running a food distribution?
Yes
No
How long have you been distributing food?
What are your operational hours?
What are your food distribution hours?
Zip Code Areas/Cities Served
Separate Areas/Cities with a comma
How many individuals do you serve per week (on average)?
Number only
How often can they receive food (1x/month, 2x/month/weekly)?
Have you run a food distribution in the past?
Yes
No
If Yes to running a food distribution in the past, please describe.
Do you have a staff or volunteer leader for the food program you propose?
Yes
No
Number of Paid Staff
Number of Volunteers
How do you conduct outreach to clients?
What is your capability/interest in providing grocery Home Delivery services?
Inquirer's Electronic Signature
Inquirer's Signature
Enter full name
Signature Date
Inquirer's Title
SHFB Contact Information
