Local Food Purchase Assistance (LFPA) Request Form

**THIS IS NOT AN ORDER FORM, NOR DOES IT GUARANTEE FOOD DELIVERY**


MAFRAC is working with 4P, a local food hub, to help distribute food provided by the Local Food Purchase Assistance Cooperative Agreement (LFPA). This program is specific to Virginia: “Building an Equitable and Resilient Local Food System: Connecting Virginia Farmers with Virginia Families."


MAFRAC needs to determine the interest and demand from our stakeholders for this program. Please fill out this survey to indicate your interest and capacity for receiving free food, and to describe your distribution plan, should we be able to deliver free food to your organization. Thank you for all you do in support of our communities!


If you have any questions, please send an email to Liz@mafrac.com.

Information about your organization:

Select or enter value
Caret IconCaret symbol

Please check this box if you confirm that your organization provides food to underserved communities throughout Virginia.

Information about the types and quantity of food your organization is interested in recieving:

This food would come in large pallets and would be a great way for people to "grab and go." Palletized food would be the most cost effective, giving your organization more food than if it were to come in pre-packed boxes. You would also be able to have pallets of various types of foods (produce, meats, dairy, shelf-stable).

Select
Caret IconCaret symbol

Select the number of pallets you would be able to distribute.

Select
Caret IconCaret symbol

Small boxes are intended to serve an individual. They would come pre-packed with an assortment of food such as produce, proteins, dairy, and shelf-stable items.

Select
Caret IconCaret symbol

Select the number of small boxes you would be able to distribute.

Select or enter value
Caret IconCaret symbol

Medium boxes are intended to serve families. They would come pre-packed with an assortment of food such as produce, proteins, dairy, and shelf-stable items.

Select
Caret IconCaret symbol
Select
Caret IconCaret symbol

Please select ALL of the types of food your organization would be interested in receiving.

Select or enter value
Caret IconCaret symbol

Select all items your organization would NOT like to receive or would have a hard time distributing.

Select or enter value
Caret IconCaret symbol

Information about the people you serve:

Select the approximate number of people you serve weekly.

Select or enter value
Caret IconCaret symbol
Select
Caret IconCaret symbol

Example: Our organization serves a population that is approximately 70% hispanic, 20% black, 10% white. Many of our people are elderly who are homebound.

*The more details you provide the better we are able to report to receive more funding of this type.

Logistical information:

We need to know how you are able to receive this food and if you have the ability to help other organizations in your area. For example, you may have a large indoor or outdoor area where other organization may pickup food or you may have cold storage. We are looking to be as efficient as possible in order to reach more people in need. Thanks in advance for your collaboration and help!

Select
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol

Tell us more information about how often and when you serve so that we may best coordinate with your organization.

Select
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol

Provide information here, such as how long you can store food and how much. Example: We have a large parking lot that we can use to have a large quantity of food dropped off. We will have our customers come to the parking lot. We can also accommodate other organizations as long as they pick it up within the same day.

Example: We do not have any room for food, but we can pickup the quantity of food we request at a nearby location.

Provide any additional information you would like us to know in order to better help serve your organization.