The Salvation Army of Greater Green Bay
Seasonal Assistance Registration Form -- Food Only

This online registration form will take the place of in-person interviews for the 2020 Christmas Assistance programs. Food only requests are for Brown County residents who are elderly or disabled, but able to come to our Christmas distribution location to pick up their food basket.
**If you are elderly or disabled and in need of a food basket delivery, do not complete this form and contact Karrie at 920-593-2362 instead.**

Food Basket registration must be completed by November 30.

If you are unable to complete the form online, a paper copy of the form may be completed outside at The Salvation Army Corps Community Center, located at 626 Union Court, on the following dates and times:
Thursday, October 1: 8am-10:30am
Thursday, October 8: 4pm-6pm
Tuesday, October 13: 2pm-4pm
Saturday, October 17: 8am-10am
Monday, November 30: 9am-11am

Name

Address

Age

Phone Number

Alternate Phone Number

Other Adult in Household

Age

Current Total Monthly Household Gross Income

Certification

Terms

I certify that the information provided above is true and accurate.
I understand that my information may be shared with other social service agencies to avoid duplication.
I understand that my registration is not fully complete/confirmed until I receive my confirmation letter in the mail.

I, the undersigned, agree to the terms above.

Almost done. Where should we send the confirmation?

Name

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