Your Neighborhood Food Truck Site visit REQUEST FORM

Your Neighborhood Food Truck Site visit REQUEST FORMThank you for your interest in Your Neighborhood Food Truck!Hunger Free Colorado is the state’s leading anti-hunger organization leveraging the power of collaboration, systemchange, policy change and social change to end hunger in Colorado. To help connect families to available food andnutrition resources, Hunger Free Colorado (HFC) launched a new kind of food truck—Your Neighborhood FoodTruck—that will visit local neighborhoods throughout the Denver metro area. It’s serving up access to computersand personal support to help local residents apply for the Supplemental Nutrition Assistance Program (SNAP), aswell as offer information on nearby food pantries and other nutrition programs.If you would like to request Your Neighborhood Food Truck to visit your site or event, please complete and submitthe following form. You can submit the form by opening with Adobe Reader, completing and selecting “Submit”when finished, the form will be sent directly to HFC. You may also submit the form by mailing to:Hunger Free ColoradoAttention: YNFT Lead7000 S. Yosemite St. #170Centennial, Co. 80112ORGANIZATION INFORMATIONOrganization Name:Organization Physical Address:Organization Mailing Address:Organization Phone:Website:

CONTACT INFORMATIONContact Name:Contact Title:Contact Email Address:Contact Phone:How did you hear about YNFT? (Select from dropdown list)If you heard about us word of mouth from another agency, please share the agencies name:Is this the first event you have requested a YNFT visit? YES NOEVENTEvent/Site Name:Number of Expected People:Event/Site Date: Event/Site Start Time: Event/Site End Time:Location of Event/Site:Any special instructions when arriving to event/site?Brief description of event/site:*YNFT schedule is finalized one month in advance; please submit this request form one month inadvance from the date of your event.GENERAL QUESTIONSDescription of services, mission, or goals of your agency:

How would you describe the community your organization serves? (Select all applicable)SuburbanUrbanHow many unique individuals are served at your location each month?How many individuals may be eligible for the Supplemental Nutrition Assistance Program (SNAP),formerly Food Stamps, at your site?What population/s do you serve? (Select all applicable)Individuals Families Seniors 18 and under Homeless All OtherINFORMATION PACKAGEHunger Free Colorado will provide YNFT program information, is your organization willing to distributeand post this information prior to the event? (Check box) YES NOYNFT Needs for Visit(select if each are available)YNFT will need at least 13 feet of clearance to enter into a site location. YES NOTo enter and exit the location YNFT will need approximately 12 parking spaces. YESNOYNFT requires 6 parking spaces to park across horizontally at the site. YES NOOnce YNFT is fully expanded it will require a space of 15’x40’. YES NO