Application – Covering The Gap

Basic eligibility criteria: Single person household annual income no greater than $30k and Multiple person household annual income no greater than $60k.

Please understand that all application approval/denials are on a case by case basis. We understand that everyone’s situation is different. If your income is a bit higher than the basic eligibility – apply anyway!

Application

All fields are required. Please allow 2-3 business days for a response.

Name*

First

Last

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email*

Cell Phone*

Preferred method of contact*

Date of Birth*

day

month

year

Please select all that apply: (optional)

HIV+

LGBTQ+

POC

How did you find us?*

How many people live in your home and what are their ages (include yourself)?*

Are you employed? If so, where do you work, how many average hours per week do you work, and how long have you worked there?*

Have you been denied or "incomed out" of SNAP and/or WIC? *

How much do you currently spend weekly on groceries?*

Do you have a kitchen you can cook in?*

What are your grocery needs? (meats, dairy, household items, etc.)*

What do you consider your cooking ability?