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FOOD BANK BENEFITS APPLICATION
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Residence
RENT
OWN
CAMPING
OTHER
Specifically for those who live in Sedona, Village of Oak Creek, Cornville, or Page Springs.
Verifiable proof of residency required from Sedona, Village of Oak Creek, Cornville, or Page Springs, such as but not limited to the following:
-Driver’s license
-Arizona ID
-Utility bill
-A child’s report card from local school
-Rental agreement or receipt of payment
-Correspondence, ie: phone bill, insurance (car or health) bill
-Camping receipt
-P.O. Box
All persons in the household must show proof of residency.
*Without proof of residency, only limited assistance will be available.
Upload your verification file
Household Size. List members in household if more than one.
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Name
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Last
Date of Birth
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Relationship
Name
First
Last
Date of Birth
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Relationship
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Last
Date of Birth
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Relationship
Name
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Last
Date of Birth
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Relationship
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First
Last
Date of Birth
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Relationship
Check the sources of income - We may use this information to obtain grants for support.
WAGE
PENSION or SOCIAL SECURITY
VA BENEFITS
DISABILITY
OTHER
Check if you have these monthly expenses
RENTAL
PUBLIC SERVICES
Is there more than you would like to tell us about your change in circumstances that brought you here?
QUESTIONAIRE
We want to be sure that food given to your family is food you want to eat. Our objective is to offer food that will be enjoyed and not wasted. Please put a check mark next to those foods your family would prefer.
FOOD ALLERGIES?
YES
NO
Food allergies, special medical conditions (such as diabetes), or food needs - if you prefer to say so.
FOOD TYPE PREFERENCE: (Check all that apply)
VEGAN
VEGETARIAN
GLUTEN-FREE
DIABETIC
PREFERRED FOODS: (Check all that apply)
HOT CEREAL
COLD CEREAL
TOMATO SOUP
CHICKEN NOODLE SOUP
CREAM SOUP
VEGETABLE SOUP
CANNED GREEN BEANS
CANNED PEAS
CANNED CORN
CANNED MIXED VEGETABLES
CANNED PEACHES
CANNED PEARS
CANNED PINEAPPLE
BLACK BEANS
KIDNEY BEANS
PINTO BEANS
REFRIED BEANS
BROWN RICE
WHITE RICE
SPAGHETTI
MAC & CHEESE
PEANUT BUTTER
JELLY
TUNA
MILK (if available)
YOGURT (if available)
CHEESE (if available)
EGGS (if available)
BUTTER (if available)
JUICE (if available)
FROZEN FOODS (if available)
LIST ANY SPECIFIC TYPES OF FOOD YOU PREFER FOR CEREAL, PASTA, OR OTHER FOODS.
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