Little Acts of Giving – 501(c)(3) Donate to Strengthen Michigan Communities

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Gifted

Food insecurity / Emergency need

Head of Household Name:

Email:

Phone:

Address:

Number of family members:

Date:

Eligibility (Check all that apply)

Income at or below TEFAP guidelines

SNAP / EBT benefits

Medicaid

SSI / Disability

TANF / Public Assistance

Food insecurity / Emergency need

Food Provided

Dairy

Produce

Canned Goods

Protein

Grains

Other

Notes:

Volunteer or Staff Initials

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Contact Info

Little Acts of Giving

15821 19 Mile Rd

Clinton Township, MI 48038

Email: info@littleactsofgiving.org

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