Food Assistance Form Name * First Name Last Name Phone * (###) ### #### Email Family Size * Family of 1-2 Family of 3-4 Family of 5-6 Family of 5-8 Other If Other Please List Family Size Checkbox * I understand that the food assistance is available to the needy. By checking this box you confirm that you are in need, or are filling out this form for someone in need. I understand that I will receive a phone call to schedule an appointment for food pickup or possible delivery if applicable. I certify that I or the person in need lives in Santa Rosa County FL, Escambia County FL, or Escambia County AL. We will be in contact with you soon to schedule an appointment for pick-up or possible delivery if applicable. Food is given out as it is available and we strive serve our community as much as possible. However, there may be times food resources are limited and this could affect your request. If you have any questions or need immediate help please call (850) 992-6345.Thank you!! If you have any questions please call (850) 992-6345.
