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Family Application

Instructions
Please fill out all the fields in order for your application to be considered for membership. Incomplete applications will not be approved. Please note that we primarily use email communication, so you must have a valid and current email address in order to participate.

Birch Community Services does not discriminate in any of its activities or operations on the basis of race, color, religion, gender, sexual orientation, national origin, disability, marital status or any other legally protected classification.

Emergency Food Resources

Snow Cap
17805 SE Stark
Portland, OR
503-674-8785

Portland Adventist
Community Services (PACS)
11020 NE Halsey
Portland, OR
503-257-2500

Oregon Food Bank
(Call for food assistance in your particular area)
503-252-05555

Sunshine Division
(For emergency food box)
503-823-2119

211 can provide free guidance and
information about family resources
Dial 211
Text the keyword children to 898211
Email children@211info.org
Visit 211info.org

< Back to Applications

Agency Application

Instructions
Please fill out all the fields in order for your application to be considered for membership. Incomplete applications will not be approved.

Have you read through the website and guidelines to fully understand the BCS program?

Yes No

First Name

Last Name

Your Title

Is your Agency a 501c3 Nonprofit?

Yes No

Organization

Phone Number

Your Address

Address Line 2

City

State

Zip Code

How are you funded?

What other sources do you have for assistance (food, etc)?:

How often do you receive other assistance?:

Why do you desire the assistance of Birch Community Services?:

What is your primary target group?:

How often do you provide food/goods to your target group?:

What are the days and times you distribute?

Approximately how many people do you feed in that timeframe?:

Where do you distribute and what does the facility provide? Do you store and serve at the same location?

What food safety practices do you have in place?

What is the date you have or will begin to distribute in this manner?

How do you advertise or spread the word to your target group?

I have additional questions about:

Please upload your 501c3 Letter of Determination.

I understand that nothing I receive from BCS may be sold or traded.

Other Resources

Snow Cap
17805 SE Stark
Portland, OR
503-674-8785

Portland Adventist
Community Services (PACS)
11020 NE Halsey
Portland, OR
503-22-8500

Oregon Food Bank
(Call for food assistance in your particular area)
503-252-05555

Sunshine Division
(For emergency food box)
503-823-2119

211 can provide free guidance and
information about family resources
Dial 211
Text the keyword children to 898211
Email children@211info.org
Visit 211info.org

Family Application

Please Answer Each Question

Reference 1 (Personal):

Reference 2 (Professional/Non-Family Member):

Emergency Food Resources

Agency Application

Other Resources

Are you looking to apply as a family for the Sustainable Families Program or to apply as an agency?

Families

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