Prospective Partner Form
Thank you for your interest in becoming a Partner Agency of Clark County Food Bank (CCFB).
View our eligibility requirements
Please fill out this interest form with more information on your work in the community.
Please note that completion of this form does not guarantee a partnership.
We greatly appreciate your support of our mission to alleviate hunger and its root causes.
Questions? Please e-mail partner@clarkcountyfoodbank.org
Organization Information
Organization Name
Program Name (if different than above)
Website:
Organization Address
Street Address
Street Address 2
City
State
Postal Code
Is Mailing Address the same as above?
Yes
No
Street Address
Street Address 2
City
State
Postal Code
Does your agency have 501(c)3 or church designation?
Yes
No
If no, does your program/agency have a fiscal sponsor? A fiscal sponsor is a separate non-profit organization that provides fiduciary oversight to your organization.
Yes
No
Fiscal Sponsor Information
Organization Name
Organization Address
Street Address
Street Address 2
City
State
Postal Code
Is Mailing Address the same as above?
Yes
No
Street Address
Street Address 2
City
State
Postal Code
Fiscal Sponsor Contact Name
Phone Number
Email Address
Organization Contact Information
Food Program Coordinator Name
Phone Number
Email
Director Name
Phone Number
Email
Organization Information
What is your organizations mission?
What services does your organization provide?
Describe the population served by your organization:
What geographic areas do you serve?
*
(counties, cities, zip codes, schools , etc.)
Food Program Information
Food programs can look a lot of different ways, each organization is unique in the way they operate. Using the prompts below, please tell us more about how your organization operates it's food program.
Does your organization have an established food program?
Yes
No
Describe your current food program:
How long has your food program been in operation?
How many individuals does your food program serve each month?
How often does your food program operate? Include days / hours of operation.
How often can an individual receive food through your program?
How does your food program currently acquire food for distribution?
Does your program have ability to distribute fresh and/or frozen food items?
Yes
No
Do you distribute food for free?
Yes
No
If no, please describe your fee structure:
Does your program have transportation and ability (vehicles and staff/volunteers) to pick-up food from Clark County Food Bank Warehouse?
Yes
No
How does partnering with Clark County Food Bank benefit your organization and/or food program?
Name of person completing this form:
Email Address
Thank you for submitting a
Prospective Partner Interest Form.
We review new inquiries monthly and will be in touch after our review.
Contact Information