Agency Application

Applications
are now Open

Potluck Food Rescue is now accepting applications for January 2025. By 2026, we will require each agency to have a ServSafe Manager certification or an equivalent food safety certification.

If you have questions about this, please reach out to cwyman@potluckfoodrescue.org.

If you are looking to be a recipient of Potluck Food Rescue for Livestock Feed and/or Compost, please complete the application below. If you are looking to become a recipient agency for food for human consumption, please complete our Agency Application on our website. This form is ONLY for Livestock and/or Compost recipients.

LIVESTOCK/COMPOST APPLICATION

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MAILING ADDRESS

P.O Box 2515588
Little Rock, AR 72225

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PLEASE NOTE

Processing time for applications can take 7-10 days. We will get back to you, promise!

Agency Application

If you are a non-profit with a need to feed your constituents, or if you are a church, or a school, please fill out this application to see if we can help each other feed the community. If you are an individual looking for a food pantry in your area, please visit www.foodpantries.org.

Step 1 of 3 - Contact Information

33%

Organization/Employer

Name of the Main Contact

First Last

Business Name

Contact Information

Address of the organization your applying for

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(ies) served

Contact Email

Contact Phone Number

Can this phone receive text messages?

Yes

Name of person that is responsible for picking up donations (if different than above)

Are you a 501c3, church, school, or similar organization?(Required)

Yes

Please upload a copy of your 501c3 IRS designation letter

Max. file size: 300 MB.

EIN

What is your annual operating budget for the current year?(Required)

Is your organization operating under the umbrella of another 501c3 or church?(Required)

Yes

Upload a letter of support from that organization on their letterhead.

Please make sure there is contact information for the Director/Key Staff of that organization listed on the letter.

Max. file size: 300 MB.

It's time to pause.

If you are not a 501c3, church, or school and you do not have a qualified partner, we are not ready to move forward just yet. You will need to find a community partner to work with in order to receive food from Potluck Food Rescue. If you have any questions, please reach out to our director Sylvia Blain at sblain@potluckfoodrescue.org or call the office @ 501-371-0303.

Organization Type and Needs

Type of Organization

Help us understand what type of work you do. Check all that apply.

Food pantry

Soup kitchen

Street outreach

Shelter

Operate a "free store"

Mutual aid/benefit organization

Other We will ask you more when we reach out.

Tell us more about your organization.

What days do you serve the community?

Approximately how many people do you serve?

1-20

21-50

51-100

101-200

>201

Are you a member agency of the Arkansas Food Bank Network?

Yes

What is your approximate annual food budget?

What percentage of your food is purchased?

0-25%

26-50%

51-75%

76-100%

What percentage of your food is donated?

0-25%

26-50%

51-75%

76-100%

What percentage of your food is grown for you or by you?

0-25%

26-50%

51-75%

76-100%

Capacity and Storage

Provide information on what kitchen equipment your agency currently has on-site

Tell us about your kitchen and/or food storage area

How do you store frozen items? How do you store refrigerated items? Do you have commercial storage space or residential appliances? Do you cook on site?

Can you pick up food from Potluck between the hours of 9am and noon on your assigned day?

Yes

What type of vehicle(s) will you use to pick up your donation?

This helps us determine the maximum size of your donation. This does not mean we will be able to fill each vehicle to capacity.

Is someone in your organization ServSafe Handler Certified?

Yes

If NO, is someone in your organization willing to become ServSafe Handler Certified?

Yes

Starting January 2025, in order to be a partnering agency with Potluck Food Rescue, it is a requirement that at least one individual working with each partnering agency receive a ServSafe Handler Certification. This ensures safe food handling practices. There will be a thirty day grace period for an organization to get a ServSafe Handler Certification. You can visit ServSafe.com and take the online test. It is a $15 cost to your agency.

If your application is accepted, an onsite visit to your organization is required before pick ups from the Potluck Food Rescue warehouse can begin.

Would you allow a visit from the Potluck Food Rescue Executive Director or Operations Manager?

Yes

Let us know any other important information here.

Agency Application

Applications
are now Open

MAILING ADDRESS

PLEASE NOTE

Agency Application

Contact Information

It's time to pause.

Organization Type and Needs

Capacity and Storage

DID YOU KNOW?

DID YOU KNOW?

Agency Application

Applications are now Open

MAILING ADDRESS

PLEASE NOTE

Agency Application

Contact Information

It's time to pause.

Organization Type and Needs

Capacity and Storage

Applications
are now Open