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Ozaukee Food Alliance Registration Form

Welcome to the SCFP! Eligible Ozaukee County residents may use the food pantry ONCE PER MONTH.

To register for services, you must provide:

1. Proof of residency in Ozaukee County (state ID card or utility bill). (Bring along your first time!)
2. Names and birth dates of all household members. (Enter below!)
3. Estimated monthly income. (Enter below!)
4. Other demographic information, which will be kept strictly confidential. (Enter below!)

That’s it! WELCOME! We look forward to serving you.

Email(Required)

Name(Required)

First Last

Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Phone(Required)

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

How did you hear about us?(Required)

Summer Lunches for Kids

Facebook

Newspaper

Word of Mouth

Another Agency Referred

Other

Best way to contact you?(Required)

Email

Phone

Mail

Other

Estimated monthly income(Required)

Are you currently employed?(Required)

Yes

No

Are you or is anyone in your household a veteran?(Required)

Yes

No

Are you currently homeless or in temporary housing?

Yes

No

Prefer not to say

Do you have SNAP benefits or need assistance in applying for SNAP benefits?

Yes

No

Prefer not to say

Do you have any health issues or problems with transportation that make it difficult to come into the pantry?

Yes

No

Prefer not to say

Do you have other household members? 1(Required)

Yes

No

Additional Household Member #1

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Do you have other household members? 2(Required)

Yes

No

Additional Household Member #2

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Do you have other household members? 3(Required)

Yes

No

Additional Household Member #3

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Do you have other household members? 4(Required)

Yes

No

Additional Household Member #4

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Do you have other household members? 5(Required)

Yes

No

Additional Household Member #5

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Do you have other household members? 6(Required)

Yes

No

Additional Household Member #6

Name(Required)

First Last

Date of birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Ethnicity(Required)

Alaskan Native

African American

Asian

Hispanic

Native Hawaiian - Pacific Islander

Native American

Middle Eastern

Multi

White

Other

Contact

Phone

262-689-8591

Mailing Address

PO Box 80341
Saukville, WI 53080

LOCATION

166 W. Dekora Street
Saukville, WI 53080

View directions

Quick Links

Schedule your visit
Pantry schedule
Meal Site schedule
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Host a food drive
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Name(Required)

First Last

Email(Required)

Mobile Phone

By entering your mobile phone number, you acknowledge that you may receive occasional text messages from Ozaukee Food Alliance.

What is 7 plus 5?(Required)