Agency Monthly Report | The Dayton Foodbank

Reporting for the month of*
In the year of*
Reports must be submitted to The Foodbank no later than the 5th of the month following the month to which the report pertains.
Agency Name*
Address*
Street Address Address Line 2 City State ZIP Code
County*
Name of Person Completing Form*
Email of Person Completing Form*

Type of Program*
Number of People Served (one day high attendance)*
Number of Children Served (one day high attendance)*
Number of Meals Served (plate count)*
Number of Students Served (one day high attendance)*
Number of Pantry Visits*
Tiered pantries should fill this form out only if you are not using PantryTrak or VCM.
Tiered Pantry Report

A
With minor children

B
Without minor children

C
Totals
1. Number of Households
Number of Households with minor children*
Number of Households without minor children*
Number of Households Total*
2. Number of Seniors Served (age 60+)
Number of Seniors Served with minor children*
Number of Seniors Served without minor children*
Number of Seniors Served Total*
3. Number of Adults Served (18 - 59)
Number of Adults Served with minor children*
Number of Adults Served without minor children*
Number of Adults Served Total*
4. Number of Children Served (birth - 17)
Number of Children Served with minor children*
Number of Children Served without minor children*
Number of Children Served Total*
5. TOTAL Number of People Served
Number of People Served with minor children*
Number of People Served without minor children*
Number of People Served Total*