Commodity Supplemental Food Program (CSFP) – Participant Interest Form

Commodity Supplemental Food Program (CSFP) – Partner Agency Interest Form

Thank you for your interest in participating in the CSFP program serving seniors in our community. Gleaners has a limited number of slots available for enrollment. We also have a limit on the number of new applications we can process monthly. As a result, not every organization that requests to participate will be able to participate. We’ll let you know as soon as we are able when spots open up and will maintain a waiting list of interested organizations.

Agency Name(Required)

Agency Address(Required)

Contact Name(Required)

Contact Title(Required)

Contact Email(Required)

Contact Cell Phone(Required)

Does your organization receive CSFP or senior food boxes from another organization, such as Focus Hope or OLHSA?(Required)

How many seniors (age 60+) do you currently serve through your location through non-CSFP programs?(Required)

Can you enroll 40-50 seniors in the CSFP senior food box program?(Required)

Do you have adequate staff to manage client applications, check client IDs, and distribute boxes?(Required)

Can you commit to complete and accurate reporting of boxes distributed each month?(Required)

Are you willing to take Civil Rights Training each year?(Required)

Do you have refrigeration/cooler space available for the cheese (one two-pound block per person)? (Even if you do same day distribution, you must have refrigerated space available in case of no shows or returns.)(Required)

Do you have adequate storage available for the boxes? Boxes are 12”x12”x12” each and must be kept off the floor in a well-ventilated area that is free from pests(Required)

How do you plan to distribute the boxes each month? (Pickup/Delivery)(Required)

Commodity Supplemental Food Program (CSFP) – Partner Agency Interest Form

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