Organization Name: Contact Name: Affiliation to Organization: Organization’s Best Point of Contact Phone Number: Organization’s Best Point of Contact Email: Does your organization have a tax exempt status under 501c3 from the Internal Revenue Service (IRS)? Yes No Does your organization have financial sponsorship to cover food costs? Yes No Has your organization worked with Food Bank of Central New York in the past? Yes No What method of distribution are you expecting to offer (Drive-through, Walk-up, Market-style)? In what county will the distribution be located? Cayuga Chenango Cortland Herkimer Jefferson Lewis Madison Oneida Onondaga Oswego St. Lawrence Requested site address: Does distribution site have adequate space to accommodate recipients, volunteers and distribution vehicles? Yes No Do you have traffic control plan/partnerships in place? Please provide detail. Requested length of time for distribution? 2 Hours 3 Hours 4 Hours Do you have capability to store food items? Yes No Do you have capacity to refrigerate food during distribution? Yes No Number of households your organization would like to serve? Please give detail on how you would conduct outreach to the food insecure population in your region? Please describe your event: Requested date: Preferred days and times for the event OR days of the week for the event (e.g. Monday morning, Monday afternoon, Tuesday morning, Tuesday afternoon, etc.):
