New Applicant Intake & Enrollment/Initial Box
Participant Name:
Date:
Household Size:
Monthly Income:
ID Type:
Participant presented and applied for Food Pantry services. The participant met with the Case Management Department to complete a comprehensive needs assessment. The assessment was conducted collaboratively with the assigned Case Manager, during which the participant’s immediate needs were reviewed and additional programs and supportive services available through the agency were discussed.
Based on the information provided and documentation reviewed, the participant was determined to meet all eligibility requirements for enrollment in the Food Pantry Program. The Case Manager provided a detailed overview of the program, including service guidelines and frequency of assistance.
The participant’s request for a food box was approved. The food box was issued on the same date, and the Pantry Attendant assisted the participant with unloading the box. Services were rendered in accordance with program policies and procedures.
[Title] – [Name]