IIFM Food Pantry Intake Form
All FB Partner Agencies of CENC-FB are required to use an intake form
NOTICE TO CLIENTS
If you receive food from this emergency pantry, please note the following:
This emergency food pantry is a Partner Agency of the Central & Eastern North Carolina Food Bank (CENC-FB), and as such has agreed to follow CENC-FB policies and procedures and Internal Revenue
Service (IRS) regulations regarding distribution of donated goods.
This pantry CANNOT:
- Charge a fee or accept monetary donations for food and non-food items you receive.
- Require you to provide a service, participate in a religious event or join any part of this organization as a condition of receiving food.
- Refuse assistance to you based on race, color, age, religion, national origin, disability,
gender, sexual orientation or political affiliation.
*This pantry must implement guidelines and post them where clients can see them stating any limitations that would affect service, stating the following:
- Pantry days and hours of operation.
- How often your household may visit this pantry.
- Form of identification, if any, necessary to receive food.
- Any service area restrictions (Example: serves only specific zip code or school boundary).
- Refuse service to individuals posing a health hazard, been verbally or physically abusive or have threatened harm to volunteers, staff or other clients.
*Pantry guidelines MUST be clearly posted.
17 Colleys Ln. Cameron, N.C. 28326