Food Pantry Application
Pathway Food Pantry orders can be submitted once every 30 days.
Please fill out all of the below information thoroughly.
If you are filling out information on behalf of another person, please enter their information.
If you have any questions, feel free to call the PCC office at
260-469-4444
* First Name
* Last Name
* Mobile Phone
Email
* Birth Date
* Address
Address 2 (Apt/Suite # etc.)
* City
* State/Province
* Zip/Postal Code
* Total number of individuals in household
* 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.
* By entering my name in the box below, I agree to the above conditions and affirm that I have answered all questions honestly in regard to my living arrangement, financial situation, and involvement with Pathway. (Please enter full name below)
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.
* Are there any allergies or special needs of which we need to be aware?
Vegetables
Peas
Carrots
Green beans
Corn
Mixed
Tomatoes (diced, sauce, paste, etc)
Yams
Potatoes
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 2 or 3)
Ketchup
Mustard
Mayo
BBQ sauce
Ranch dressing
French dressing
Italian dressing
Assorted Dressing
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
Baby Soap/Shampoo
Wipes
Diapers - Size 1
Diapers - Size 2
Diapers - Size 3
Diapers - Size 4
Diapers - Size 5
Diapers - size 6
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
Ground Venison
Bread
Refrigerated Items
Eggs
Cheese
Lunch Meat/ Smoked Sausage/ Hot Dogs
Butter
Yogurt
Milk
Any additional information we may need?
Add Another Person
Processing registration ...
Cancel
Safari Users Click to Register
Chrome Users Click to Register