Pantry Registration - Fall Creek Township

Office Phone: (317) 841-3180

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Pantry RegistrationSteven Ray2022-11-17T03:11:52-05:00

Fall Creek Township Pantry Registration Form

Food Pantry Announcements Will Appear Here When Applicable

Please complete the Fall Creek Township Pantry Assistance Registration Form below to submit your information for office evaluation regarding your qualifications. Only the asterisk fields are required for the form to send, but other information is appreciated. Your completed information is encrypted during transfer.

First Name «

Last Name «

Street Address «

City «

State «

Zip Code «

Previous Address if Moved in Past Year

Phone «

Your Email «

Social Security Number

Your Birth Date

Marital Status:Never MarriedMarriedSeperatedDivorcedWidowed

Household Information

Home Status:Own HomeRentingLiving ArrangementHomelessOther Situation

Years at Current Address?

Number in Household?

Number of Children Under 18?

Current Employment Status

Total Household Gross Income (before taxes)

Name ALL Sources of Income in Household

Do You Receive SNAP (Food Stamps), Yes or No?

SNAP Amount Received per Month

Any Peanut Allergies?

Any Household Disabilities?

Other Food Pantries Used

I would like to receive further information and updates from Fall Creek Township: YesNo

I certify that I am a member of the household above and that all information provided regarding my household is true and accurate, and understand that any false statements or misrepresentation will result in forfeiture of assistance. By submitting this document, I am giving Fall Creek Township written consent to share pertinent information with local community agencies to verify your information on an as-needed basis. These agencies will be held to the same level of confidentiality as Fall Creek Township.

Please take a clear photo of your driver's license and any recent utility bill to verify your residence. Browse and select one image at a time BEFORE submitting the registration form. Accepted formats include: JPG, JPEG, PNG, BMP, TIF, PDF, DOC, DOCX, PPT, PPTX, ZIP, and RAR.

Please leave this field empty.

Fall Creek Township Offices

11595 Brooks School Road
Fishers, Indiana 46037

Phone Numbers
Office Phone: (317) 841-3180
Fax: (317) 841-3191

Office Hours
Mon – Fri: 9 AM – 4 PM
Pantry: Tue – Thurs: 10 AM – 2 PM
Closed National Holidays

Non-Emergency Fire Department:
(317) 846-2525

Non-Emergency Medical Services:
(317) 846-2525

Sheriff’s Office:
(317) 595-3300

11595 Brooks School Road
Fishers, Indiana 46037

OFFICE PHONE & HOURS

Office Phone: (317) 841-3180
Office Hours: Mon - Fri 9am - 4pm
Pantry Hours: Tue - Thur 10am - 2pm
Closed National Holidays

TRUSTEE & BOARD MEMBERS

Doug Allman, Trustee
Jason Meyer, President
Brian Baehl, Secretary
Tony Scott, Board Member

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