ICNA Relief Food Pantry Registration & Selection List

ICNA Relief Food Pantry Registration & Shopping List
Greetings,
Please note that ICNA Relief-Tampa Food Pantry currently provides Emergency Food Assistance ONLY. (COVID-19 Relief). Please complete form if qualified. We report data to our national Hunger Prevention office and share outcome measures with the USA National Hunger Prevention Initiatives.
We have created this system for convient distribution. Please select the items NEEDED. Our intentions are to assist with your grocery needs as much as possible. Please note that some items may not be available.
We will contact you when your order is ready for pick-up or delivery. Please be patient. These are challenging times and volunteers are taking precaution to ensure the safety of themselves and family.
For questions, Contact: 813-770-3241 (No message, Text) or email Tampa@icnarelief.org Subject: Food assistance Needed
Thank you
Emergency Food Assistance Qualifications
Are you an ICNA Relief Food Pantry Client (Registered prior to COVID-19 May 2019 to March 21)
Today's Date
MonthDayYear
Date
Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Area CodePhone Number
Please list food allergies:
# of Adults age 65 or older
# of Adults age 18 - 64
# of Children age 6 - 17
# of Children age 0 - 5
BREAKFAST : Select 2 items
Select 2: Hot Beverages, etc
Select 2 : Spices, Seasonings, Canned Tomato items
Select 2: Baking Foods
Select 2: Protein/Snacks
Select as needed: Canned Vegetables and Beans (# of items determined by family size/availability)
Select 1 : Canned Meat/Fish
Select 4: Can, Jar, Bottle, Box
Select 2: Pre Cooked/Meal Kits/ Olives, Sauces etc
Dried Soups/Noodle
Select 2: ( Salty)
Select 2: (Sugar) Cookies
Baby Food : As needed
Other
Select 1: Dried Beans
Select 2: Pasta
Other
Select 1: Rice
Select 2: Prep Meals, Pasta, Rice, Potato,
Select 1: Grains , Flour, International
Drinks: Select as needed ( # of items determined by family size)
Special Items: Only 2 items provided at this time. Select by preference. 1 to 6
Other
Baby Diapers
Adult Diapers
Halal Meat
Meat: Select 1st Choice, 2nd , 3rd, 4th ( Amount given is based on family size and availability)
Rows Chicken Beef Lamb Goat Falafel/Vege
First Choice
Second Choice
Third Choice
Fourth Choice
Bakery Items:
Produce and Dairy (Provide when available)
Frozen Dinners
Food Pantry Location: 7326 E. Sligh Ave. Tampa, FL 33610
Signature
Clear
Should be Empty:

Rows	Chicken	Beef	Lamb	Goat	Falafel/Vege
First Choice
Second Choice
Third Choice
Fourth Choice

ICNA Relief Food Pantry Registration & Shopping List