Food Needs Assessment
The Jamestown Family Resource Center, The Tuolumne County Superintendent of Schools, and Resiliency Village Are Partnering to Help Get Food to Families During This Emergency.

Food Assessment – We remain committed to low-barrier food distribution during this emergency and keeping everyone as safe as possible.  We’ll do our best to get to all of you while making sure those in the most need get service as quickly as possible.  Please be honest when answering these questions so we can take care of everyone.  We will get back to you with the resources closest to where you live.  If you don’t have a way to fill out this form online please call (209)536-2092 between 9 am and 3 pm.

Jamestown Family Resource Center is operating in an emergency capacity.  We are doing everything we can to keep staff, volunteers and the public safe. Please do not come to the center without an appointment.

Sign in to Google to save your progress. Learn more
Email *
IMPORTANT:
All answers and information you submit is strictly confidential. You won't receive a separate confirmation, but can expect that we’ve received your request and will respond within 24 hours.
Name *
Phone number [numbers only, no parentheses or dashes] *
Full Address *
Street, City, State, Zip
Who lives in your house?  How many...
Fill-in below
Adults 18-59  
Adults 60 +  
Children 6-17
Children under 5
What school do or would your children attend?
Is anyone in your house disabled?
Do you have transportation or a way to pickup food?
What is the level of need in your household?
Additional information for us
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy