Food Assistance
Use this form to apply for grocery delivery every two weeks through cooperation with the Ashfield Food Pantry. Please email office@marylyonfoundation.org with any residency documentation.
Please email or call the office 413-625-2555 with any questions about the form or delivery.
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Email *
Family Name and contact person's name for delivery if different *
Phone number *
Mailing address: Include physical address and any PO Box address *
Number of family members *
Family members aged 0-17.  Please list name, age and gender for each person aged 0-17. *
Family members aged 18-65.  Please list name, age and gender for each person aged 18-65 *
Family members aged 65+.  Please list name, age and gender for each person aged 65+. *
Does your family want milk? *
Grocery drop off can take place at one of the following locations or be sent home on the bus. The pick up will take place at the dismissal time of the school or school program. Please select how/where you would like to collect your groceries. *
You must provide proof of residency for the groceries. Please take a picture of your recent utility bill and email it to office@marylyonfoundation.org. The photo must include your name and address. Please include "Grocery Delivery" in the subject line of your email. You could also bring a copy of the document to the MTRS at 26 Ashfield Road.  The main office will place your envelope in our mail box. *
Please share any dietary or food allergy information with us here.
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