Apply for a kit.

Application Instructions:

*Please fill out all required fields.

*Please include any other special questions, dietary restrictions and/or other relevant information in the message field.

*Please wait for an email to confirm pick-up dates and time. SHIP Kits will only be distributed by schedule and appointment only.

* No walk-ins for kits will be given.

Name

First Name

Last Name

Cell Phone Number

What is your ZIP code?

How many people live in your household?

Including yourself

Do you have transportation to pick-up a SHIP Kit?

Do you have children in your household?

If you have children in your household, what age range?

Do you have a nut allergy?

Are you using services of any of the following organizations?

Please select all that apply.

Hunger at Home

SOMOS Mayfair

LUNA

AACAS

Office of Supportive Housing

African American Community Service Agency

Recovery Cafe

Grail Family Services

None of the above

Additional Information?

If there is anything you think our team should know, please add it here.