Monthly Statistical Report for Shared Harvest Foodbank

For the Month of 20

Complete appropriate Statistical Sections. Reports must be submitted to the foodbank no later than the
15th of the month following the month to which the report pertains.


 Name of Agency:
                                                                                        Check here if any new information

 County: Email:

 Name of Person Completing Form:


Food Pantry: A part of a foodbank network that distributes food and grocery products to low-income households, including food from sources other than USDA, to relieve situations of emergency and distress. It is housed in a standing facility that distributes commodities, among other food and grocery products, on a regular basis.

FOOD PANTRY Statistical Section                          HOUSEHOLDS                TOTAL
                                                                                        With Minor       Without Minor
                                                                                          Children           Children
   A. Number of Households                                                               
                                                                                         --------------------------------------------------
   B. Number of Seniors Served (age 60 & older)                           
  C. Number of Adults Served (age 18 & 59)                                   
  D. Number of Children Served (birth to 17)                                   
                                                                                         --------------------------------------------------
  E. TOTAL Number of People (B+C+D)                                         


  Meal Site: Provides meals to people in need.
  Shelter: Provides nights of shelter to homeless
  people, run away children or victims of abuse.		  MEAL SITE and/or SHELTER Statistical Section
 A. Number of People (head count) Served:
 B. Number of Meals (plate count) Served:  

 CONGREGATE and/or RESIDENTIAL MEALS Statistical Sections*
 A. Number of People (head count) Served: 
 B. Number of Meals (plate count) Served:    		  Congregate or Residential Meals:
  Primary service is not food distribution; but meals are included as
  part of the services provided, including Residential Treatment
  Facilities, Child or Adult Day Care, Senior Citizen Center, Group
  Home, Youth Program, Summer Camp, etc.

 Comments:
Thanks for All You Do!

 Mail To: Shared Harvest Foodbank, 5901 Dixie Highway, Fairfield, Ohio 45014-4207  
FAX To: 513-874-0152                    OR CALL: Chuck at 800-352-3663 or 513-874-0114