Nutrition Education Healthy Pantry Program Interest Form Organization Name* Address* Primary Contact Name* Primary Contact Phone Number*Primary Contact Email Address* Is at least 50% of your audience considered low-income?*YesNoNot SureIs your organization a current partner agency of the East Texas Food Bank?YesNoPantry Distribution ModelPre-packed boxesPartial choice (clients select some items while other items are pre-packaged)Sheet client choice (clients select food items off a list and volunteers pack the items)Walk-through client choiceOther (list below)Untitled Does your pantry provide a reliable supply of healthy foods (F2Es - Foods to Encourage)?YesNoNot SureDoes your pantry have the opportunity to promote healthy foods?YesNoDoes your pantry have a history of successfully adopting innovation/change? Please explain.Please list any potential barriers or challenges your pantry might face in participating in the Healthy Pantry Program.
