Request Food : Application

Organization Information

Email *

Organization Name *

Mailing Address Street *

Mailing Address City *

Mailing Address State *

Mailing Address Zip Code *

Phone Number *

Website

What is your organization’s mission statement/purpose?

How did you hear about Waste Not Want Not? (Please be specific)

Name of Head of Food Program(First Name) *

Name of Head of Food Program(Last Name) *

Email address for Head of Food Program *

Cell phone number for head of Food Program *

Please describe your Food Program in detail, including how you plan to use the food you hope to receive from Waste Not Want Not. *

If different from mailing address, full address where the distribution, preparation and/or service of food will take place.

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Does your organization purchase food from retail and/or wholesale stores? *

Does your organization have dry good storage? *

Does your organization purchase/receive food from Feeding Northeast Florida? *

What type of refrigerated storage does your organization have?

Does your organization receive food from Farm Share? *

What type of freezer storage does your organization have?

Does your organization receive food from USDA Emergency Assistance Food Program? *

Does your Food Program distribute groceries?*

Does your organization provide clients items other than food? *

Does your Food Program serve cooked food indoors? *

If so, please list the non-food items that you provide

Does your Food Program serve/distribute prepared food outdoors? *

How often does your organization distribute/serve food? *

Is your Food Program part of a residential program? *

Please elaborate on when you distribute/serve food. (For example: "The first Saturday of every month" or "every Monday, Wednesday, and Friday" or "three meals a day" or "distribute Thanksgiving baskets".)

Is your Food Program part of a meeting/counseling/tutoring program? *

What time of the day does your organization distribute/serve food? *

Is your Food Program a weekend backpack program? *

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Approximately how many people does your organization help per service?*

Do you primarily serve veterans? *

Which age group do you serve most?*

Do you primarily serve individuals with differing abilities? *

Do you primarily serve homeless individuals? *

Do you have a certain population (not already listed) that your organization specifically attempts to help? *

If so, what is the target population?

Does your Food Program limit service only to people who live in a specific geographic area? *

If so, please specify zip codes or counties

Does your Food Program have any other criteria to determine whom you will serve? *

If so, please specify

Do you restrict how often recipients may receive food?*

If yes, please specify the frequency

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Please select the days that you are NOT available to pick up food from Waste Not Want Not. (Please keep in mind that we are open EVERY day except Christmas and Thanksgiving.) [To select multiple options, hold down the Ctrl (windows) or Command (Mac) button.]

I understand that our organization must be a 501(c)(3) or a church in order to receive items from Waste Not Want Not. (Please email a copy of your federal tax determination letter to wastenot@wastenotflorida.com. If you are unable to submit this electronically, please mail a copy of your 501 (c)(3) determination letter to Waste Not Want Not, PO Box 119, Orange Park, FL 32067. ) *

I understand that a representative of my organization must pick up food at Waste Not Want Not’s facility at the agreed-upon time on the agreed-upon date. I understand that it is therefore our responsibility to notify Waste Not in advance (no later than 9 a.m. the day of pick up) if we cannot receive food as scheduled *

I certify that my organization and its representatives will not sell, offer for sale, transfer or barter any of the food provided by Waste Not Want Not, that the food will be used for charitable purposes (used in its generally acceptable legal sense, which includes relief of the poor, the distressed or the underprivileged; advancement of education; lessening the burdens of government; and combating community deterioration and juvenile delinquency), that we have the refrigeration and food preparation/storage capabilities that we indicated we have, and that we will not deny anyone food provided by Waste Not Want Not on the basis of race, creed, national origin, religious affiliations, gender, sexual preference, age or handicap. *

Organization Information

Food Program Information

The following questions relate to how your Food Program obtains and stores food.

The following questions relate to how and when your organization provides food and other items.

The following questions relate to the population that your organization serves.

The following questions relate to any restrictions on service by your Food Program.

The following question relate to your ability to transport food from Waste Not Want Not.

The following certifications are required in order to receive food from Waste Not Want Not.