FOOD PANTRY DONATION REQUEST Whole Foods Market on Metcalf 7401 West 91

st Street Overland Park, KS 66212

www.wholefoodsmarket.com/stores/metcalf

Thank you for your patronage and for thinking of us for help with your fundraising efforts. There are many worthwhile organizations supporting the community that Whole Foods Market would be proud to work with. Please pardon us as only organizations receiving a donation will be contacted. Please do not call to check on the application’s status. This is one-page donation application form is intended for local food pantries interested in applying for the annual Holiday Grab & Give food drive program. (Other types of donation forms are available online.) During the Grab & Give program, customers donate either a breakfast, lunch or dinner to feed a family of 4 in need during the months of November and December. Whole Foods Market then gives the all natural foods donated to the recipient food bank(s) for distribution to the local community. These meals are pre-selected to be pantry stable. In order to approve your requests, we need the following form and information by October 15

th submitted in person at Customer Service. Phone

and mailed requests are not accepted. If you have missed the deadline, please consider us for your organization’s future donations. Please attach any additional information to the form. Also attach copy of agency’s 501(c)3 tax-exempt paperwork, if applicable. See additional guidelines on page 2 if you have questions.

Name and Address of Applicant Organization:

Street City ST

Zip Phone Fax

Contact Person Title

Contact Person’s Email Address ____________________________________@__________________________

Person Submitting the Application if different than the Contact: _____________________________________________________

Application Date: __________ Organization’s web address _____________________________________

Is the food pantry address listed above? If not, please write it here: ___________________________________________

If selected, do you have a truck and driver who can pick-up food on a weekly basis from Whole Foods Market? Yes, No

What cities and zip codes does this food pantry serve? __________________________________________________________

______________________________________________________________________________________________________

When do you serve food from the food pantry? Daily Weekly Monthly Other: __________

TIMES: Mon. _______ Tues. _______ Wed. _______ Thurs. _______ Fri. _______Sat. _______ Sun._______

How many people does the pantry serve each week? ___________How many people CAN you serve in a month? __________

How many volunteers to you have? ___________

Who is eligible to receive a food from your food pantry? __________________________________________________________

______________________________________________________________________________________________________

Is the food pantry supported by or sponsored by another organization? If yes, what organization: _________________________

Does your organization assist those in need in other ways, and if so what are those ways? (Ex. Do you provide emergency shelter or have a thrift

store?) __________________________________________________________________________________________________

What is your storage capacity for food? ________________________________________________________________________

Please describe how you distribute food to those in need: __________________________________________________________

________________________________________________________________________________________________________

How do you communicate with those you serve? _________________________________________________________________

________________________________________________________________________________________________________

How do you communicate with your volunteers and supporters? (mail, social media, media affiliates, web, etc._____________________________

________________________________________________________________________________________________________

Have you received a donation from any Kansas or Missouri Whole Foods Market in the past 12 months? __________

Are you also requesting a donation from our 119th Street Whole Foods Market? _________

For Internal Use Only

RECEIVED BY __ _____ __ Date_______ FP_________ FY_________ Form Updated: 8-2012

FOOD PANTRY DONATION REQUEST Whole Foods Market on Metcalf 7401 West 91

st Street Overland Park, KS 66212

www.wholefoodsmarket.com/stores/metcalf

Dear Donation Seeker:

Thank you again for your patronage and thinking for thinking of us. We ask that you look over the following criteria before

submitting your request for a Food Pantry Donation. Other donation forms can be found online.

1. Requests must be applied for in writing and in person. Donation requests are available at the Customer Service Desk.

2. Phone requests are not accepted, and due to the large volume of applications we are not able to return all messages

regarding the status of a donation. Only those receiving a donation will be contacted.

3. The recipient must be a 501-C (3) nonprofit organization (includes schools). A copy of the 501-C (3) letter from the IRS

must accompany the application. This letter comes from the Treasury Department and is different from the state

tax-exempt form.

4. The application must be received by October 15th

to be considered for the Grab & Give holiday program in order to be

considered.

5. All applications are reviewed by a panel. Because the donations budget is limited, early submission of your application is

recommended. Due to the volume of requests we receive, we are not able to respond to all requests.

6. Whole Foods Market has specific guidelines for the organizations we are able to support with donations. In addition to

being a non-profit, the event you are conducting or the activities of your organization must fall into one or more of the

following:

Environmental Preservation

Preventative Health Care

Hunger Relief

Organic Farming / Sustainable Food Resources

Children, or the very local community

Education on any of the above

7. Because Whole Foods Market believes in being an active community member, requests from other civic and charitable

groups will be considered if the organization is in the immediate vicinity of a store location, meets our core values, and

funding is available.

8. Past support of an organization or event is not a guarantee of future support. Although we would like to support every

worthwhile cause, due to the volume of applications, it is not possible for Whole Foods Market to fulfill every request.

Thank you for your interest.

Best Regards,

Jennifer Matascik

Store Marketing Specialist

Whole Foods Market-Metcalf

7401 W. 91st Street

Overland Park, KS 66212

(913) 652-9633