Monthly Service Statistics Report Form Food Pantry Programs

Due date: By 10th of following month (i.e. January due by February 10th)

When not to send a report: Never!
When to send zero report:
If you did not serve any food during the month
When to send regular counts: If you serve food, regardless of where the food is obtained

Fill out online or print it
and mail to:
Feed My People Food Bank
2610 Alpine Road
Eau Claire, WI 54703
Or fax to: 715-835-3844

Statistics are for the month and year of:
Agency:		Agency ID Number:
Contact Person:		Phone Number:
Email:
Address:
Individuals Ages 0-17: Individuals Ages 18 - 64 Individuals Ages 65+ Households Pounds/ Vouchers Regular Service (1st Visit this month) Extra Service (2nd+ Visit this month) Total for this month First Visit of Year
Comments:
Check One:	Food and non-food products are weighed on a scale
	Pounds are estimated
CAPTCHA:
	(Copy random code above into text field provided)

How to report Regular Service:

This is an unduplicated number. Each household counted here should be different. Therefore, only count a family's first visit this month in this section.

How to report Extra Service:

If you serve the same family more than once this month, report their additional visits here. For instance, if the same family comes three times this month, record their last two visits in this section.

How to report Pounds/Vouchers:

Everything that you distribute to a family during their food pantry visit should be reported here. That includes food and non-food products and cash or product vouchers redeemable at a store. All food and non-food items should be weighed on a scale. For vouchers, you may use the formula: 1 dollar = 1 pound.

How to report First Visit of Year:

This is the number of people served for the first time in 2010. For example, if a mother comes for the first time in February and she has three children, enter four. If the mother visited the pantry in November 2009, you should still record four for February. Her family should not be counted again in 2010.

If you are unsure of how to record your statistics or you have any questions, please call us at 715-835-9415.