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Become A Partner Agency Interest Form
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
Name of Organization
(Required)
Organization Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Food Storage/Distribution Site Address (If Different From Above)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
What County is Your Feeding Program In?
(Required)
If your county is not listed, it is not within the service area of Second Harvest of the Big Bend. To locate your local food bank, please visit this website: https://www.feedingflorida.org/feeding-florida/florida-food-banks If you are located in Dixie, Columbia, Suwannee, Hamilton, or Lafayette County, please contact Florida Gateway located in Lake City at 386-755-5683. Please do not complete the rest of the form if your county is not listed. Thank you for your understanding.
Calhoun
Franklin
Gadsden
Gulf
Jackson
Jefferson
Leon
Liberty
Madison
Taylor
Wakulla
Columbia
Hamilton
Suwannee
Dixie
Lafayette
What Type of Organization Are You?
(Required)
Emergency Food Pantry
Soup Kitchen
Emergency Shelter
Residential
Day Care (Child or Adult)
Senior
Rehab
Youth Programs (School)
Multi-Service
Other
Describe Your Organization and Its Mission
(Required)
Does Your Organization Have a 501(c)3 or have church qualifying documents?
(Required)
Yes
No
Do You Currently Operate a Food Distribution or Feeding Program?
(Required)
Yes
No
If Currently Operating a Food Distribution or Feeding Program, How Many Households Do You Serve Per Month?
How Many Households/Families Would You Have the Ability To Serve Per Month If You Had More Food Resources Available?
(Required)
Do You Currently Have a Dedicated Food Budget?
(Required)
We recommend that our partners have a budget to order food directly from Second Harvest of the Big Bend, that is available at, or well below, wholesale cost.
Yes
No
Does Your Organization Have the Capacity to Create a Dedicated Food Budget for Partnership with Second Harvest of the Big Bend?
(Required)
Yes
No
Please Describe Your Organization's Food Program, Including Length of Time in Operation
(Required)
What Days Are You Currently Distributing To the Community? (Example: Every Tuesday or the 4th Friday of the Month)
(Required)
Where Does Your Organization Currently Receive Food From?
(Required)
What Do You Require of Neighbors to Receive Food?
(Required)
Please Describe the Population or Geographical Area You Serve
(Required)
Which Population(s) Utilize Your Current Program or What Individuals Do You Expect to Utilize Once You Begin Operating?
(Required)
Children
Families
Seniors
College Students
From The Following Descriptions, Which Distribution Styles Are You Interested In?
(Required)
Choice Pantry- allow neighbors to "Shop with Dignity" by selecting their own items from the available products during their advertised open hours. It is preferred that this be set up in a grocery or market style with a staff/volunteer person available to assist the shopper.
Pre-Packed Distribution- provide nutritious food that is pre-packed by your organization in equal quantities and distributed to neighbors inside the physical location during the designated pantry operating hours.
Drive Thru Pantry- provide nutritious food that is pre-packed by your organization in equal quantities and handed to neighbors as they drive up in their vehicles during the designated distribution date and time.
How Many Regular Volunteers Does Your Organization Have To Assist With Your Distribution/Feeding Program?
(Required)
Do You Have Dedicated Staff/Volunteers Who Can Act As a Program Coordinator?
(Required)
Yes
No
Do You Have Dedicated Staff/Volunteers Who Can Travel to Second Harvest of the Big Bend's Warehouse to Pick Up Food on a Routine Basis?
(Required)
Our warehouse is located at 4446 Entrepot Blvd in Tallahassee, FL.
Yes
No
Do You Have Dedicated Staff/Volunteers Who Can Submit Monthly Reports Via Computer?
(Required)
Yes
No
Second Harvest of the Big Bend Primarily Communicates with Partners Electronically. Do You Have Consistent Access to Internet and Email?
(Required)
Yes
No
Do You Currently Have A Refrigerator(s) or A Walk-In-Cooler that Could Be Dedicated to Food Storage for Your Food Distribution/Feeding Efforts? If So, Choose Which Type Below
(Required)
Standup Refridgerator
Chest/Reach In Cooler
Walk-In-Cooler
Other
None
Do You Currently Have a Freezer(s) or A Walk-In-Freezer that Could Be Dedicated to Food Storage for Your Food Distribution/Feeding Efforts? If So, Choose Which Type Below
(Required)
Standup Freezer
Chest/Reach In Cooler
Walk-In-Freezer
Other
None
Please Describe Any Temperature-Controlled, Non-Cold Storage Areas You Intent to Use for the Food Program
Include description of approximate square foot of area, number of existing shelving units, and type of shelving or other ambient temperature storage currently available. Reminder - must be a space that receives regular pest control maintenance.
Do You Have a Delivery Space that Meets the Following Requirements?
(Required)
1. Large enough drive-up area for a CDL truck to safely enter and exit 2. Concrete area to unload pallets
Yes
No
Please Describe Any Other Non-Food Services Your Organization Offers at This Time?
(Required)
Please Describe Any Barriers You Anticipate to Becoming a Food Program Partner
(Required)
Additional Comments You Wish to Provide
(Required)