<p> River Cities Harvest</p><p>Recipient Agency Application </p><p>1.Name of Agency: ______</p><p>2. Address: Street ______</p><p>City ______State ______Zip ______</p><p>3. Agency phone number: (day) ______(evening) ______</p><p>4. Normal operating hours for agency: ______</p><p>______</p><p>5. Can agency be available at other times? Evenings yes ( ) no ( ) Weekends yes ( ) no ( )</p><p>6. Person(s) to contact at location during normal operating hours to discuss pickup and/or receipt of food.</p><p>1. ______</p><p>2. ______</p><p>7. Information on persons to contact in evenings and on weekends.</p><p>Evening contact: Name ______Phone ______</p><p>Weekend contact: Name ______Phone ______</p><p>8. Please tell us about your funding. What is your annual budget and where do those funds come from?</p><p>______</p><p>9. How does the agency serve the community? How many clients? Please be specific about the number of meals the agency serves each day/week/month and tell us when the meal is served or when the pantry is open and how the food is distributed.</p><p>______</p><p>10. How much food does the agency need each week or month?</p><p>______</p><p>11. What types of food does the agency need regularly?</p><p>______</p><p>12. What types of food does the agency need on occasion?</p><p>______</p><p>13. What types of food does the agency never need?</p><p>______</p><p>14. Can the agency handle perishable foods? Yes ( ) No ( )</p><p>15. Give a description of refrigerated storage.</p><p>( ) None</p><p>( )Small- one refrigerator or cooler</p><p>( )Medium- multiple units. Number of units-______</p><p>( )Large- storage of reasonable amounts of food is not a problem.</p><p>16. Give a description of freezer capacity.</p><p>( ) None</p><p>( ) Small- household type freezer</p><p>( ) Medium- multiple units. Number of units- ______</p><p>( ) Large- storage of reasonable amounts of food is not a problem</p><p>17. Does the agency have an available truck or van and driver to pick-up either produce, perishable or canned foods?</p><p>1. Weekdays Yes ( ) No ( )</p><p>2. Evenings Yes ( ) No ( ) 3. Weekends Yes ( ) No ( )</p><p>18. Is the agency willing to provide a volunteer to do regular pick-ups from grocery stores or restaurants, with the donated food going to your agency? Yes ( ) No ( )</p><p>Please provide the names of these volunteers and how to reach them. ______</p><p>19. Does the agency have volunteers that would be able to help RCH in other special projects throughout the year? Yes ( ) No ( ) Fundraisers, food drives, special events, garden projects. Please list volunteer names and contact information. </p><p>______</p><p>20. Agency comments:</p><p>______</p><p>River Cities Harvest recommends that all agencies visit the Facing Hunger Food Bank website at facinghunger.org to fill out their application and register with their organization.</p><p>Return completed form to: River Cities Harvest P.O. Box 2136 Ashland, KY 41105</p>