Registration Form for Healthy Food at No Cost

Who is this form for?

This form is for people needing help in finding healthy food at no cost. If you are contacting us for a different reason, please visit

How to complete this form:

Please complete all sections of this form. We want to contact you as soon as possible, so it is important that your phone number and email are correct. Please double check your answers before hitting the green submit button at the bottom.


We often request documentation. However, if you do not have documentation, please tell us your reason for needing help accessing health food. Click the options that apply to you/your family.

I/my family receives government or income assistance

I/my family receives RAP benefits

I/my family falls within the Low Income Cut Off (LICO) Guidelines


How many adults live in your household?