SVdP Georgia Support Center Food Assistance Request

SVdP Georgia provides food assistance at our Chamblee and Atlanta/Lakewood pantry facilities. This form is used to request food assistance to families in need and can be submitted by any of our Georgia Conferences or Authorized 3rd Party agencies.  Please fill out the online form below to submit a request for a family/individual in need of food assistance.  Once received, our staff will schedule directly with the family/individual in need of assistance.

Note to SVdP Conferences: You no longer need to add an In-Kind Food Assistance to your CMS Case Record for the specific family/individual you are serving. CMS recording will be performed at the Conference Support Center on your behalf.

"*" indicates required fields

Location*
Please check one.
Chamblee FSC*
Please select ONE option. Note: Chamblee location is open for shop thru on Monday, Tuesday, Thursday and select Saturdays.
Date of Referral*
Caseworker's Name*

Client Information

Caseworker, please complete this form in its entirety.
Name*
Address*
Please list out any special item requests like diapers, formula, etc. here.
List ALL adults and children to be served (including individual named above)*
Click the + symbol to the right to add additional names.
Name
Age
 
Hidden
Consent
Hidden
Hidden
Date