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

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