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Mobile After Report
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* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Location of Mobile Pantry
*
Choose
Adams
Beaver Dam
Beloit #1
Boscobel
Bridge Lake Point
Darlington
Fort Atkinson
Gays Mills
Highland
Janesville: First Lutheran
Janesville: St. John Vianney
Marshall/Waterloo
Monroe
Norwalk
Pardeeville
Patch Grove
Platteville
Portage
Reedsburg
Richland Center
Ridgeway Church
Rimrock Route
Sparta
Tomah
Triangle/Brittingham
Allied
Date of this Mobile:
*
MM
/
DD
/
YYYY
PORTION QUANTITY
sent by Second Harvest
(shown at top right corner of e-mailed menu):
*
Your answer
Total
HOUSEHOLDS
(HH) served?
Note:
Make sure you include any Volunteer's household if they registered and received food AFTER their shift
*
Your answer
Total
EXTRA PORTIONS
(XP) served?
*
Your answer
Combined
TOTAL
PORTIONS
given?
Note:
this should always be larger than the total Households!
*
Your answer
How many
PORTIONS
should we send next time?
*
Your answer
Total
PEOPLE
in those households?
*
Your answer
(Catholic Charities mobiles only)
How many
First Time Households
attended?
Your answer
How many
volunteers
helped at this mobile?
*
Your answer
How many total volunteer
hours?
(approximation is fine)
*
Your answer
When is your next Mobile?
*
MM
/
DD
/
YYYY
Do you need us to send grocery bags next time?
*
Yes, PAPER bags (while supplies last)
Yes, PLASTIC bags
No
Other:
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