Good Grocer | Do Good. Good Food.

Step 1 of 6 - Purpose

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Purpose

We’re closing the gaps that restrict access to healthy food by empowering our underserved neighbors to enjoy the same high-quality foods and products we sell in our store for up to 50% off. Everything we sell at the Food Outlet is top quality. If we wouldn’t buy it, we won’t sell it. If you’re currently experiencing food insecurity, or are unable to afford all the food you or your family needs, you’re invited to shop at the Good Grocer Food Outlet.

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Applicant Information

First Name*

Last Name*

Date of Birth*

Email*

Enter Email Confirm Email

Street Address*

Apt / Suite / Other

City*

Zip Code*

Cell Number*

Household Size (including yourself)*

How did you hear about the Food Outlet?*

Building Sign

Care Provider

Friend/Family

Social Media

Internet

Other

Are you also interested in learning more about becoming a volunteer at Good Grocer?*

Yes

Have you been a member of the Food Outlet before?*

Yes

Questions

Please read each of the following statements. For each statement, please select the answer that best describes your food situation in the last 6 months.

My food runs out before I get money to buy more.*

Often true

Sometimes true

Never true

In the last 6 months, I have cut the size of my meals or skipped a meal in order to save money.*

Often true

Sometimes true

Never true

I can’t afford to eat healthy, balanced meals.*

Often true

Sometimes true

Never true

I am currently enrolled in SNAP (food stamps) or WIC government assistance programs.*

Yes

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If Answer True/Yes

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If Answer Never/No

Food Outlet membership is limited to individuals experiencing food insecurity. We define food insecurity as anyone with limited or uncertain access to food of sufficient quality or quantity to sustain a healthy and active life. Based on your answers, you don’t qualify for a Food Outlet membership. If you believe there are extenuating circumstances that would make you eligible, please email the Food Outlet help team at contactus@goodgrocer.org.

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Commitments & Conditions

By placing a checkmark next to each statement, you indicate that you have read and agree with the following food outlet commitments and conditions.

Myself or someone in my immediate family is experiencing limited or uncertain access to food of sufficient quality or quantity.

I understand that my Food Outlet membership will expire after 6 months and can be renewed for an additional 6 months if I am still experiencing food insecurity.

I understand that I am the only authorized shopper at the Food Outlet and each time I shop I must present some form of identification.

Electronic signature*

By signing, you acknowledge and accept Good Grocer’s food outlet commitments and conditions.

Food Outlet Application

Purpose

Purpose

Applicant Information

Questions

Please read each of the following statements. For each statement, please select the answer that best describes your food situation in the last 6 months.

If Answer True/Yes

If Answer Never/No

Commitments & Conditions

By placing a checkmark next to each statement, you indicate that you have read and agree with the following food outlet commitments and conditions.