Apply for Food Relief

Please complete the form below to apply for food assistance.

Important Information

Please fill out this application slowly and carefully. Make sure all information about your household is correct. Only one application is allowed per household. If information is missing or incorrect, your application may be delayed or you may lose food benefits. Please allow at least one week for review.

Food Relief Application

Personal Information

Full Name *

Phone Number *

Email Address *

Address *

City *

State *

Zip Code *

Household Information

Number of people in household *

List all household members (names and ages)

Total monthly household income *

Dietary Information

Do you have any dietary restrictions or allergies?

Halal onlyVegetarianGluten-freeDairy-free

Please list any food allergies

Pickup Preferences

Preferred pickup day *

Tuesday (12:00 PM - 3:00 PM)Thursday (12:00 PM - 3:00 PM)Saturday (12:00 PM - 3:00 PM)

Do you have transportation to pick up food? *

Additional Information

Is there anything else we should know about your situation?

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that the Islamic Center of Muncie may verify this information. I also understand that food scheduling emails and links are only for my household and must not be shared with others. *

I agree to check my email regularly and respond to any messages from ICM regarding my application. I understand that failure to respond may result in delays or loss of food benefits. *

Cancel

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