2010 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

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:_____________________________________ ID Number: __________________

Contact Person: ______________________________ Phone Number: _______________

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 (Use back if needed):________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Check One:
Food and non-food products are weighed on a scale
Pounds are estimated

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 Emily or Judy at 715-835-9415.

ORDER FORM
FOOD PANTRY STAT FORM
ON-SITE STAT FORM
NEW PARTNERS