Prospective Agency Request for Membership Form

Feeding Tampa Bay reviews prospective agency interest forms on a rolling basis.

Agencies who meet our requirements for partnership will be notified as they are matched to a food-sharing program based on the needs of our community.

Please Note- FTB has an extensive list of organizations that wish to partner with us. Filling out the interest form only constitutes being put on the list. You will be notified when the decision is made to further your membership process. Thank you for your patience, understanding, and support and we hope to be able to partner with you in the future.
Prospective Agency Request for Partnership Interest Form
Today's Date*

MonthDayYear
Contact Person*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Name of Organization*
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Food Storage/ Distribution Site Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What county is your Feeding Program in?*

HillsboroughPinellasPascoHernandoSumterCitrusPolkHardeeHighlandsOther
What type of organization are you?*

ChurchMinistryOutreachShelterOther
Does your organization have a 501(c)3?*

YesNo
Does your organization have a Consumer's Certificate of Exemption (Florida State Tax Exempt Certificate)?*

YesNo
Do you currently operate a food distribution or feeding program?*

YesNo
What type of program do you operate or plan to operate? Check all that apply*

Pantry/Food BoxSoup Kitchen/Hot MealsEmergency ShelterResidential CenterRehab CenterSeniorYouth ProgramMulti-ServiceOther
Please describe your organization and its mission*
Please describe your organization's food program, if applicable
Where does your organization currently receive food from?
How often is your organization distributing food?*

DailyWeeklyBi-WeeklyMonthyN/AOther
What day/s are you currently distributing to the community?
Ex- Every Tuesday or the 4th Friday of the month
What time(s) are you currently distributing to the community?
Ex- 9:00-11:00 am
How many households/ families do you currently serve per month?*
How many households/ families would you have the ability to serve per month if you had more food resources available?*
How many regular volunteers does your organization have to assist with your distribution?*
What type of transportation do you have to pickup food?*

CarVanPickup TruckCargo VanBox TruckRefrigerated TruckOther
How many refrigerators do you have?*
What type of refrigeration do you have?*

Standup RefrigeratorChest/Reach in CoolerRefrigerator/Freezer ComboWalk in CoolerNoneOther
How many freezers do you have?*
What type of freezer space do you have?*

Standup FreezerChest/Reach in FreezerWalk in FreezerNoneOther
Do you have a loading dock?*
What other services, if any, does your organization offer?*

ClothingPersonal Care/Hygiene ItemsSNAP/Food Stamp Application AssistanceUtility/Rent AssistanceOther
Additional Comments
Disaster Response Questions

Please complete the following information to be considered for partnership as a disaster relief organization.
Has your agency been impacted by a disaster event? If so, please share your situation and any potential limitations/barriers.*
Describe the needs in your area, how were you made aware of these needs?*
How will your agency announce the availability of the service?*
Do you have a paved surface to accept deliveries?*
Often, disaster relief continues for months after the event, how long will your agency continue to provide services to impacted families/individuals?*
Do you plan to collaborate with any additional local agencies? If so, with which local agencies will your organization collaborate?*
How often is your organization able to distribute?*
Is the organization able to do home-deliveries?*
This institution is an equal opportunity provider.
Should be Empty:

Prospective Agency Request for Partnership Interest Form

Disaster Response Questions