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Welcome to The Interfaith Food Pantry Serving Morris County New Jersey - Warehouse/Office: 540a West Hanover Ave. Morristown, N.J. 07960 - Phone: 973-538-8049 Fax: 973-267-4972

How to Get Help

INTERFAITH FOOD PANTRY APPLICATION

YOU MUST BE A MORRIS COUNTY RESIDENT

(DO NOT LEAVE BLANKS - IF ANSWER IS NONE PLEASE WRITE NONE)

Last Name:
First Name:
Sex:
Marital Status:

SS#
Date of Birth
Age
Country of birth:

Address:

Phone #:(xxx-xxx-xxxx)
Native Language:
Race:

*Second Name on card

Last Name:
First Name:
SS# (xxx-xx-xxxx)

FAMILY LIVING WITH YOU (include * 2nd name on card) (use back of sheet if necessary)

Last Name First Name Date of Birth Relation to applicant

1.

2.

3.

4.

5.

INCOME (Please answer all questions - put none or "0" where appropriate.)
(Source includes salary, TANIF, SSD, Disability, SS, Pension, SSI, Unemployment Insurance, child support, etc.)

Monthly income for all members of household - list who they are, amount, & source for each person

1. Applicant $/month
Source(s) of Income
Position/type of work

If you have recently applied for assistance please explain:

2. Spouse/partner $/month Source(s) of Income
Position/type of work

OTHERS IN HOUSEHOLD

3. Name:

$/month Source(s) of Income
Position/type of work

4. Name:

$/month Source(s) of Income
Position/type of work

If more people please use comments section at the bottom.

*** Total Monthly Household Income (please add up) $

Please be sure to answer all the following questions!

Do you (or other members listed above) receive any of the following?

Food Stamps No Yes Amt/Month $ Who?

TANF No Yes Amt/Month $ Who?

SSI No Yes Amt/Month $ Who?

Medicaid No Yes Amt/Month $ Who?

WIC No Yes Amt/Month $ Who?

MONTHLY EXPENSES

(Please answer all questions - put none or "0" where appropriate.) If you have any unusual expenses or

circumstances that you would like to tell us about please do so here. (ie. family illness, etc.)

Rent/mortgage amt. $/month utilities $/month

Own Home Rent Apt. Rent Room *Other

* Please Explain

Automobile $/month explain:

Medical $/month explain:

Childcare $/month explain:

Other expenses/month(explain)

Why do you need help from the Food Pantry?

If referred by counselor, case worker, etc.

Please name:
Agency:
Phone(xxx-xxx-xxxx):

Special Food Needs - (low sugar, low salt, etc.)

Church/Temple/Mosque attended
Town

Religion

How did you hear about the Interfaith Food Pantry?

Additional Comments:

RELEASE FORM

By Checking this box I certify that all answers are true.
In addition, I hereby give permission for the Interfaith Food Pantry to verify the
information on this form and if I participate in any program of Public Assistance (now or in the future), I hereby give permission for the contents of my file to be shown to the staff of the IFP.

Email: foodpantry@optonline.net