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Second Harvest Outreach Partner Intake Form


Welcome to the Second Harvest outreach partner intake form. Please use this page to: 
  • Refer clients for Calfresh applications and/or free grocery programs
  • Record client information after you submit a Calfresh application



If your name is not listed here, please select an existing value and put your information in the "Comments to Second Harvest"


 Client Food Insecurity Questions


Ask the client these questions to determine if they need a referral to Second Harvest. If "yes" to any of these questions, please submit the referral and the client will be contacted within 48 hours. 
  • Within the past 12 months, have you worried about whether food would run out before you got money to buy more?     
  • Within the past 12 months, did the food you bought not last and you did not have money to get more?
  • Do you need information about available food resources near you?

                                               

To get help finding free food resources without having your information stored by Second Harvest, or if you have any questions, please call 1-800-984-3663, Monday – Friday 8am – 5pm.
Section Space
Enter Client Information




Food Connection Hotline is open Monday-Friday 8AM-5PM



Client Address




Client Inquiry for Food Assistance


CalFresh Application Information




Household Composition