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Food Distribution Program | Types of Agencies who can apply |
Requirements to Apply | Application Form




Two (2) Ways to Apply:

  1. We now have an online application that you can complete right here on our website. Just fill up the form below and hit submit.

  2. Download the * - manually print out the application form through your printer, complete it and mail to us. For our mailing address click here.

    * Please note that you need an Adobe Acrobat Reader to view the form, if your computer can't see the form, you need to download the Adobe Acrobat Reader here.

Thank you for your interest in the Foodbank of Southern California.

Below are the necessary forms and information your organization will need to apply for Agency Membership. Please complete the Agency Application online, read carefully and initialize the Agreement forms (in place of a signature you need to enter your initials), and compile copies of the supporting documents needed to be mailed to us.

NOTE: All fields are required. Indicate "NA" on the question that's not applicable to you organization and do not leave it blank.

AGENCY APPLICATION FORM
PART I. GENERAL INFORMATION
 
Name of Organization:    
Address*
City* State*
Zip Code* Email*
Office Phone*    
Director of Organization

Program Director (if applicable)
Food Program Director or Contacts (if applicable):  
1)
 Phone Number
2)
 Phone Number
Program Sites:      
  Address Site Phone No. Type of Food Storage
1)
Dry   Refrigeration  
Freezer   None
2)
Dry   Refrigeration  
Freezer   None
3)
Dry   Refrigeration  
Freezer   None
Is the organization incorporated? Yes No
Is the Organization part of a larger or parent organization? Yes No
  Parent Organization:  
  Mailing Address: City
    State Zip
  Director:  
Does your organization have tax-exempt status under Section 501 (c)(3) from the Federal Internal Revenue Service? Yes No

You will need to submit a copy of your letter of determination from the IRS. Click here for supporting documents needed.

 
Does your PARENT organization have tax-exempt status under 501 (c)(3) from the Federal Internal Revenue Service? Yes No
Is your parent organization legally responsible for the operations and liability of your program? Yes No
If "No," please explain: What is your primary source of funding?
General Liability Insurance Company's Name:    
Services Provided by your Organization    
Please describe services provided by your organization: Who is eligible for your services?
Are fees charged fo these services? Yes No
If Yes, Explain:
Agency Operation - Days & Hours    
Days of Agency Operation: Hours
Service Operation Days & Hours (ie: Food Pantry, Counseling Service, etc.):    
Geographic Service Area    
People receiving your services primarily come from:    
Cities: Zip Code(s):
Street Boundaries:      
(North)
(South)
(East)
(West)
 
   

 

 

 


 
The Foodbank of Southern California has been providing
wholesome nutritious food to children seniors and families in need!
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