Concho Valley Regional Food Bank

Fill out the form at right to submit your monthly report.

Fill in the name of your agency, reporting period and contact information.

Indicate the number of clients served for each category in the blanks in the right column.

When you have completed the form, click the "Submit" button at the bottom of the page. (Please click only once!)

Agency Food Distribution Report

Agency Name
Reporting Period
Contact Name
Contact Phone
Contact E-Mail

In reference to the Concho Valley Regional Food Bank letter "Reporting Requirements" dated February 26, 1999, agencies are required to submit a distribution report monthly. On-site feeders and pantries will only fill out the portion of the report that applies to their agency. Multi-use agencies will fill out both sections of the report. The report will pertain only to the food you receive from the Concho Valley Regional Food Bank.

The report must be in our office by the 15th of the month following the reporting period. This is a mandatory report and agencies who fail to meet this reporting date will be placed on a "hold order" status for the remainder of the month until the report is received. Agencies who consistently fail to meet the 15th deadline may have their Food Bank membership revoked.

A. On-Site Feeders
1. Number of meals or snacks provided, with Food Bank product during the reporting month:
2. Number of children under age twelve served meals or snacks listed above with Food Bank product:
3. Number of seniors over age 65 served meals or snacks listed above with Food Bank product:
B. Food Pantries
1. Total number of families served with Food Bank product during the reporting period:
2. Number of individuals in the families served with Food Bank product:
3. Number of children under age twelve in the families served with Food Bank product:
4. Number of seniors over age 65 in the families served with Food Bank product:
C. Remarks