Your name Street City State Zip code Your email Phone number Date of Birth Ethnicity Alaskan NativeAfrican AmericanAsianHispanicNative Hawaiian - Pacific IslanderNative AmericanMiddle EasternMultiWhiteOther Best way to contact You EmailPhoneMail Please click all that apply Need helpDonateVolunteer Number of Household Members 1 to 23 to 56 to 1010 and above Household Age Birth to 1718 to 5960+ Does your household currently receive Food share (food stamps) Yes, we doNo, we have applied; we do not qualifyNo, but we would like to applyNo, we do not wish to apply Application date Your message (optional) Δ