Get Food Assistance Intake Form

Completing the Food Assistance Intake Form online can help you access essential food resources. This guide will provide you with clear, step-by-step instructions to ensure you fill out the form accurately and effectively.

Follow the steps to complete your form with ease.

1. Click the ‘Get Form’ button to obtain the form and open it in your desired online editor.
2. Begin by entering the head of household information. Fill in the first name, last name, and date of birth fields marked with an asterisk, indicating they are mandatory. Provide your street address and apartment number (if applicable), along with your zip code.
3. Next, input your contact information. Enter your phone number, selecting whether it is a home, work, or cell number. Include your email address for further communication.
4. Report your gross household income. Specify the amount and the frequency of income (weekly, bi-weekly, monthly, or yearly).
5. Provide demographic information. You may specify your gender, ethnicity, and primary language. These fields are optional and not required for assistance.
6. Answer the additional questions regarding public benefits. Indicate whether you have benefits such as veteran status, disability, CalFresh, homeless status, social security, or Medicare/Medi-Cal.
7. List additional household members by filling out their first name, last name, date of birth, gender, ethnicity, and relationship to you. Remember that the fields marked with an asterisk are mandatory.
8. Review all information for accuracy. Once you are certain everything is correct, sign the form to confirm the information provided is truthful.
9. Finally, choose to save changes, download, print, or share the completed form as needed.

Complete your Food Assistance Intake Form online today to ensure you receive the support you need.