Madania Compassion

Food Pantry Order Form

Please fill the Quantity of each item and your info to have items delivered to your home:

* Indicates required field

Primary Name *

First

Last

House # *

Street *

Select One *

Email *

Phone Number *

Number of infants living with you (0-24 months) *

Number of toddlers living with you (2-5 years) *

Number of children living with you (6-17 years) *

Number of adults living with you (above 18) *

Number of seniors living with you (60+) *

Household Items

Hand Sanitizer *

Hand Sanitizer (Travel Size) *

Sanitizer Hand Spray *

Face Mask *

Facial Tissue *

Diaper size 1 *

Diaper size 2 *

Diaper size 3 *

Diaper size 4 *

Baby Wipes *

Food Items

Brown Rice (Eat Ready) (1 Pound) *

White Rice (1 Pound) *

All Purpose Flour *

Spaghetti (1 Pound) *

Pasta *

Fresh Apples (5 Pounds) *

Onions (2 Pounds) *

Potatoes (5 Pounds) *

Peanut Butter *

Strawberry Jam *

Sugar *

Pita Chips *

Cereal Bowl (Rice Krispies) *

Cereal Bowl (Rasin Bran) *

Cereal Bowl (Corn Flakes) *

Fruit Bars (Strawberry) *

Fruit Bars (Watermelon) *

Fruit Bars (Wild Berry) *

Canned Goods

Canned Pineapples *

Canned Pears *

Canned Creamed Corn *

Canned Tomatoes (Diced) *

Tuna Fish (In Water) *

Canned Mix Veggies *

Canned Pink Salmon *

Canned Spinach (Low Sodium) *

Kidney Beans (Light Red) *

Canned Spaghetti Sauce *

Canned Sweet Corn (Creamy) *

Canned Cream of Mushroom *

Canned Vegetable Soup *

Grits Corn (White) *

Dried Fruits

Shelled Walnuts *

Dried Figs *

Dried Fruit and Nut Mix *

Dried Pecans *

Dried Cranberries *

Dairy Products

Eggs (1 Dozen) *

Whole Milk (64 OZ) *

Instant Milk Powder *

Meat, Poultry, and Seafood Products

We apologize, we currently do not have any meat or seafood products.

By clicking, you agree that you are below the income guidelines. *

I Agree

Submit

Download Intake Form.

intake-form-2021-2022-updated-6.29.2021.pdf
File Size:	376 kb
File Type:	pdf

Download File

If you don't have a printer or have trouble, we will deliver the form to your house. Please let us know.

Currently we are delivering between the following areas:
North: Walden Ave. South: Broadway
West: Fillmore Ave. East: Lathrop Ave.
Note: If you are outside of this area, please let us know; we can refer you to another agency that can better serve your needs.

We deliver to the following streets:
Lathrop (18 - 302)
Harmonia (20 - 97) /Kosciuszko (23 - 176)
Rother (14 - 317)
Sobieski (18 - 318)
Madinah/Sweet (181 - 481)
Loepere (18 - 330)
Woltz (16 - 336)
Mills (19 - 340)
Paterson/A/B/C
Sycamore (892 - 1123)
Stanislaus (13 - 239)
Gibson (306 - 409)

DONATE

Donate for yourself and your loved ones today.
Madania Community Center is a non-profit 501(c)(3) organization. All donations are tax deductible.

Donate Now

VOLUNTEER

We need volunteers for food pickup, sorting and distribution, translation, coordination, outreach, and more.
Please fill out your name, email, and phone number and we will contact you.

Volunteer Now