CLIENT ELIGIBILITY VERIFICATION
Home delivery through the New Carlisle Community Food Pantry is reserved for individuals who cannot reasonably come to the pantry to pick up their food.
Please check all that apply:
- I do not own or have regular access to a vehicle.
- I am a homebound senior.
- I have a disability or mobility limitation that prevents me from reasonably coming to the pantry.
- I do not have another reliable means of transportation to the pantry.
- I have another qualifying circumstance that prevents me from reasonably picking up food from the pantry.
Verification
I certify that the information I have provided is accurate and that I am requesting home delivery because I am unable to reasonably pick up food from the New Carlisle Community Food Pantry. I understand that the pantry may contact me to verify my eligibility and that participation in the home-delivery program is subject to approval by the New Carlisle Community Food Pantry. We do not require you to disclose your diagnosis or provide unnecessary private medical information.
CLIENT ELIGIBILITY VERIFICATION
Home delivery through the New Carlisle Community Food Pantry is reserved for individuals who cannot reasonably come to the pantry to pick up their food.
Please check all that apply:
- I do not own or have regular access to a vehicle.
- I am a homebound senior.
- I have a disability or mobility limitation that prevents me from reasonably coming to the pantry.
- I do not have another reliable means of transportation to the pantry.
- I have another qualifying circumstance that prevents me from reasonably picking up food from the pantry.
Verification
I certify that the information I have provided is accurate and that I am requesting home delivery because I am unable to reasonably pick up food from the New Carlisle Community Food Pantry. I understand that the pantry may contact me to verify my eligibility and that participation in the home-delivery program is subject to approval by the New Carlisle Community Food Pantry. We do not require you to disclose your diagnosis or provide unnecessary private medical information.