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NYS Department of Health
Hunger Prevention and Nutrition Assistance Program

Food Grant Application 2013-2014


Due at the Food Bank by June 7th, 2013

All questions must be answered for applications to be considered complete and eligible for funding.

Name of Emergency Food Program is required

Type of Program is required

Site Address is required

Executive Director/Pastor is required

Yearly Food Expenses is required

Year Founded is required

Agency# is required

HPNAP# is required
*Shelters must also complete the 2013-2014 HPNAP Addendum Application for Emergency Shelters which is available online as well. The addendum will need to be faxed or sent as an attachment to the Food Bank. Fax number: (607) 796-6028.

Name of Contact Person is required

Contact Address is required

Phone is required

Fax is required

Email is required
*Shelters must also complete the 2013-2014 HPNAP Addendum Application for Emergency Shelters which is available online as well. The addendum will need to be sent as an attachment to the Food Bank.

FIRST TIME APPLICANTS ONLY
Please submit the following additional information:

A. A letter of support from a community organization that is familiar with your services.
B. Any informational or outreach material about your agency (i.e. newspaper article, flyer, brochure, etc.)

ALL APPLICANTS

1. What percentage of your food comes from the following sources? (Your best estimates are fine.)


2. a. Please identify the stores that you received donated product from.
Donated from is required
2. b. Please list any major areas that your agency would like to improve in the coming year.
Major Areas is required
2. c. How can the Food Bank of the Southern Tier help?
Field is required

Please note: Agency HPNAP food grant allocations are based on the number of people served from the previous HPNAP year and by agency performance in sending monthly statistics to the Food Bank on time. Agencies late with statistics for three months or more during July 2012- June 2013, barring extenuating circumstances, will have a reduced 2013-14 HPNAP food allocation. 

By clicking send below, your completed application will be e-mailed to Vickie Steck, Agency Services and Programs Assistant, Food Bank of the Southern Tier. Applications must be received by Friday, June 7, 2013, to be eligible for HPNAP funds. We recommend that you call and confirm your submission if you do not receive an emailed confirmation within 2 business days. Award notifications will be sent to the program contact person by July 1, 2013.



CONTACT US
388 Upper Oakwood Ave.
Elmira, New York 14903

Phone: 607.796.6061
Fax: 607.796.6028
Hours: Mon.-Fri. 8-4

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