* Please list the name and birth date of each additional person in the household and their relationship to you * Do you attend Pathway Community Church? Select one Regular Attender Do not attend Pathway regularly * Delivery services are not provided by Pathway Community Church. Are you prepared to pick up your order from our pantry at 1010 Carroll Road? Select one Yes No If you do not attend Pathway, how did you hear about our food pantry? * Employment Status Select one Employed full-time Employed part-time Not employed Receiving Disability * Please explain the reason for your request * Are you receiving assistance from any of the following? WIC SNAP None of the above Application Agreement - I understand that approval may take up to 24 hours or one business day. I understand that Pathway Community Church reserves the right to immediately deny any request if the information provided is found to be fabricated or false in any way. * Are there any allergies or special needs of which we need to be aware? Food Pantry Selection Form - Please select items you are running low on by checking the box next to your preferences from each category below. You may select as many items as you need. PLEASE NOTE: PCC cannot guarantee all of the items listed are in stock in our food pantry. This list is provided to help guide us when filling your order with the items you prefer. Vegetables Peas Carrots Green beans Corn Mixed Tomatoes (diced, sauce, paste, etc) Fruit Pears Peaches Pineapple Mandarin oranges Mixed Fruit Applesauce Beans Chili Beans Black Baked Pinto Great northern Refried Garbanzo Pork and Beans Soup Cream of Mushroom, Chicken or other variety Beef Vegetable or Stew Vegetable, Potato, or Tomato Chicken Noodle, Dumpling or Rice Chili Soup or Sauce Ramen Noodles Pasta and Sauce Spaghetti Noodles Egg Noodles Boxed Pasta (Rotini, bowtie, etc.) Pasta Sauce - Tomato Alfredo Sauce Meat and Gravy Chicken Beef Tuna Spam Pork Gravy Chicken Broth Beef Broth Vegetable Broth Meal Starters Hamburger Helper Sloppy Joe Sauce Macaroni and Cheese Sides Rice (white or brown) Rice-a-Roni Boxed potatoes Mashed Potatoes Pasta Sides Stuffing Peanut Butter and Jelly Peanut Butter - Creamy Peanut Butter - Crunchy Jelly - Grape Jelly - Strawberry Jelly - Other Canned Pasta Spaghetti-O's Ravioli Assorted Varieties Condiments (choose up to 5) Ketchup Mustard Mayo BBQ sauce Ranch dressing French dressing Italian dressing Assorted Dressing Taco Seasoning Salsa/Hot Sauce Breakfast items Oatmeal Pancake Mix Syrup Snack Bars Granola Bars Cereal Bars Pop Tarts Drinks Coffee Fruit juice Tea Powdered Milk Snacks Crackers Cookies Chips Jello Pudding Popcorn Pretzels Fruit Snacks Nuts Raisins/Dried Fruit Baking Cake Corn Bread Muffin Brownie Pumpkin Pie Filling Cereal Sugar (example Fruit Loops, Cinnamon Toast Crunch, Cocoa Puffs) Multigrain (example Wheaties, Life, Chex) Assorted Cheerios Baby items Wipes Diapers - Size 1 Diapers - Size 2 Diapers - Size 3 Diapers - Size 4 Diapers - Size 5 Pull- Ups 2T-3T Pull- Ups 3T-4T Pull-Ups 4T-5T Toiletries (choose 3) Shampoo/conditioner Toothpaste Toothbrushes Bar soap Body wash Deodorant - men's Deodorant - women's Tampons Maxi pads Cleaning Supplies (choose 3) Laundry detergent Dish soap Bathroom Cleaner Multi-Purpose Cleaner Glass Cleaner Hand Soap Paper Products Toilet paper Paper towels Facial tissues Trash Bags Frozen Items Frozen Potatoes (hash browns, fries, tater tots) Vegetables Pizza Chicken Nuggets Ground Sausage Pork Roast Ground Beef Refrigerated Items Eggs Cheese Lunch Meat/ Smoked Sausage/ Hot Dogs Butter Yogurt Bread items Milk Any additional information we may need?