Monthly Report

Feeding the Hungry Since 1982

Please view Events page for upcoming holiday events . . . . . Hot96- On Tuesday Dec 2 Text GIVE to 82474 to support the Tri-state Food Bank. . . . .Thank You Wal-Mart! - Awards TSFB $20,000 for weekend Back Pack-Food for Kids Program . . . . . International Food Festival - See events to view pictures . . . . .Buehler's Golf Outing raises $10,000 to help the hungry! . . . . .Hunger In America 2006 - Local statistics indicate more than 86,500 Tri-State residents seek emergency food assistance each year- including nearly 31,000 children and over 6,400 seniors - Click on 2006 Hunger Study for report. . . . .

Monthly Report

Downloadable Form for print

Monthly reports are due by the 15th of the following month, except Indiana and KY USDA agencies, which are due by the 5th of the following month. (i.e., January report is due Feb 15, or Feb 5th for IN and KY USDA)

TRI-STATE FOOD BANK, INC.

MONTHLY SERVICE REPORT

For Month of: USDA Agency:

County -IN: IL: KY:

Other County:

Agency Name: Agency Code:

Agency Street Address: City: Zip: Phone: Fax:

Email Address:

Hours of Operation:

Sun Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Mon Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Tue Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Wed Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Thu Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Fri Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Sat Hrs: Frequency (If bi-weekly or monthly selected, check each that apply)

1st week of mo.2nd week of mo. 3rd week of mo.4th week of mo.

Emergency Food - Food Pantry

Number of Household Served: Number of People Served:(Include all family members)

What percentage of Food Bank products made up your distribution?%

What percentage of Commodities made up your distribution?%

What percentage of products from sources other than the Food Bank made up your distribution?%

Did you need to turn anyone away this month? Yes No

If Yes, Why? Lack of Food

Lack of Volunteers

Other__________________________________________________________________

Soup Kitchens/Shelter Operations

Number of Meals Served: Number of People Served:(Include all family members)

What percentage of Food Bank products made up your distribution?%

What percentage of Commodities made up your distribution?%

What percentage of products from sources other than the Food Bank made up your distribution?%

Did you need to turn anyone away this month? Yes No

If Yes, Why? Lack of Food

Lack of Volunteers

Other__________________________________________________________________

On-Site/Residential Programs

Number of Meals Served: Number of People Served:(Include all family members)

What percentage of Food Bank products made up your distribution?%

What percentage of Commodities made up your distribution?%

What percentage of products from sources other than the Food Bank made up your distribution?%

Did you need to turn anyone away this month? Yes No

If Yes, Why? Lack of Food

Lack of Volunteers

Other__________________________________________________________________

AGENCIES IN THE GIFTS IN KIND ONLY PROGRAM

Number of Household Served: Number of People Served:(Include all family members)

Programs:

Are you interested in starting a: Kids Cafe:

Back-Pack Program:

Does someone on your staff have a Food Handlers Certification?

If no, would you be interested in a group training and certification session?

COMMENTS:

Name of person completing this form

Phone number for person completing this form