Hot Meal Program

If you knew what I know about the power of giving, you would not let a single meal pass without sharing it in some way

Coming Soon!

We are preparing to serve our community.

Meal distribution is not yet available.

Register Now!

In order to access services provided by Community Kitchen Corp, all participants are required to complete a registration process. Hot Meal Request is a outreach community service program will feed the homeless and distressed families in the area hot meals on an as needed on a weekly basis.

CKSCORP Intake Form

COMMUNITY KITCHEN SERVICES CORP

FOOD ASSISTANCE PROGRAM CLIENT INTAKE FORM

Head of Household Information

First Name *

Last Name *

Date of Birth *

Street Address *

Apt #

City

Zip Code *

Demographic information below is not required to receive food.

Phone Number

() –

Home Work Cell

Email

Gross Household Income

$

Weekly Bi-weekly Monthly Yearly

Gender

Female Male

Ethnicity

Primary Language

Creole Spanish Other

Additional Questions

Veteran Yes No

Disabled Yes No

Homeless Yes No

Active Military/Dependent Yes No

Household Public Benefits

Disability EBT Social Security Medicare/Medicaid

# of Living Household

Household Members List *

First Name *	Last Name *	Date of Birth *	Gender	Ethnicity	Relationship *

I have read the CKSCORP authorization and agree to the terms.

Signature (Type Full Name)

Date