Sign up for TheMadf Home Delivery - The Making a Difference Foundation

Hispanic/Non-Hispanic necessary birth

Name *

First

Last

Email *

Phone

What can you expect in your delivery?

- 1 box of dry goods
- 1 box/bag of produce
- 1 meat option
- ONLY if available, a dairy (eggs, milk, cheese)

***NO CUSTOMIZATIONS AT THIS TIME***

Please visit the food bank for specific dietary needs and items not offered in home delivery program.

PLEASE NOTE: You only need to sign up once.

Once you have signed up for this service we will send a delivery to you every other week unless you request removal. Please see other form for cancellation of service or updates/changes to your service (ex. address change or number change)

This form is for NEW delivery requests only:
For changes/updates and removal requests for a current service;
please scroll down for the form below this one

Eloise's Cooking Pot delivers to:
Tacoma, University Place, Parkland, Spanaway, Lakewood, Puyallup, Fife, Federal Way, Algona, and Pacific

Address

Address Line 1

Address Line 2

City

State

Zip Code

Further dropoff instructions, including doorcode if necessary

Military Service: Are you Active Duty? *

Yes
No

Household Income Eligibility

See links for current TEFAP guidelines:

English
Spanish
Chinese
Korean
Vietnamese
Russian
Somali
Ukrainian

The Written Notice of Beneficiary/Client Rights & USDA And Justice For All Poster are available here

Household Income *

Yes, I meet the income eligibility as defined by the link provided.
No, I do not meet the income eligibility as defined by the link provided.

You do not have to qualify for the income eligibility in order to receive home delivery.

Number of people in your household *

Section Divider

Person 1 date of birth

Person 1 Race

Person 1 Hispanic/Non-Hispanic

Person 2 date of birth

Person 2 Race

Person 3 Hispanic/Non-Hispanic

Person 3 date of birth

Person 3 Race

Person 3 Hispanic/Non-Hispanic

Person 4 date of birth

Person 4 Race

Person 4 Hispanic/Non-Hispanic

Person 5 date of birth

Person 5 Race

Person 5 Hispanic/Non-Hispanic

Person 6 date of birth

Person 6 Race

Person 6 Hispanic/Non-Hispanic

Person 7 date of birth

Person 7 Race

Person 7 Hispanic/Non-Hispanic

Person 8 date of birth

Person 8 Race

Person 8 Hispanic/Non-Hispanic

Person 9 date of birth

Person 9 Race

Person 9 Hispanic/Non-Hispanic

Person 10 date of birth

Person 10 Race

Person 10 Hispanic/Non-Hispanic

Person 11 date of birth

Person 11 Race

Person 11 Hispanic/Non-Hispanic

Person 12 date of birth

Person 12 Race

Person 12 Hispanic/Non-Hispanic

Person 13 date of birth

Person 13 Race

Person 13 Hispanic/Non-Hispanic

Person 14 date of birth

Person 14 Race

Person 14 Hispanic/Non-Hispanic

Person 15 date of birth

Person 15 Race

Person 15 Hispanic/Non-Hispanic

Sign-Up for Home Delivery

Household Income Eligibility

Section Divider

FORM 2

Update Home Delivery Information or Stop Home Deliveries

If you wish to change your address, contact information, household income status (annually), or be removed from the list, please enter it below.

Note that it might take up to a week for these changes to be reflected in the delivery routes.