Updated Demographic Reporting Form 
(Form updated April 2024)
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Email *
Select your Agency (Name & Number) - If you are unable to find your Agency, please ask your Site Director. *
What month and year are you completing this form for?  *
NAME of person completing this report? *
What county is your agency in?  *
What agency TYPE are you reporting for?  
(If you have multiple types of operations you will need to complete this form for each type of operation (i.e. backpack and pantry)
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