Pantry Updates 2020 – Delaware Valley Fairness Project

The Food Pantry program has changed operation. To be part of the pantry program, even if you have received food from us before, please download, fill out, and sign the following PDF form. Form instructions are below. When the form is complete, attach it with your personal details below to register.

INSTRUCTIONS FOR COMPLETING THE TEFAP SELF-DECLARATION OF NEED FORM

You are the Recipient.
Please insert your name and address.
In the upper right-hand corner, please indicate the number of children 17 years old and younger; the number of adults whose age is between 18 and 59 years; and the number of seniors 60 years old and older.
In the Total Household Income section, please circle the total number of people in your household. If more than 8, please write the number and circle it.
Please sign and date the form.
In the box on the bottom of the second page, please list the name of any person you are authorizing to receive your food. Be sure to sign on the line marked “Client Signature.”

Food Pantry Order Form - COVID

"*" indicates required fields

Name*

First Last

Phone Number*

Address

Street Address Address Line 2 City State ZIP Code

File

Max. file size: 16 MB.

Food Pantry Order Form - COVID

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