We ask each household receiving food through the East County Food Pantry. The pantry is at Smith Memorial Presbyterian Church. We request them to register with SIMC. This form will help us to better serve our communities. It will allow us to gain a better understanding of people’s experiences and backgrounds. With this knowledge, we can improve our programs and advocate for more resources to benefit our neighbors.

Any information you share is confidential and kept private within the Oregon Food Bank network. This information will not be shared with the government or be used to restrict the services you receive. We are an equal opportunity provider. No services will be denied if you choose not to fill out this form. You are welcome to share as much or as little information as you would like.  You will need to provide your information only once. This can be done at any of the Oregon Food Bank partner agencies that use SIMC. 

If you have any questions, or need help filling out this form, please ask a staff person or volunteer onsite. We are happy to help. 

To be eligible to receive food, you must self declare your income. Ensure it is at or below the income listed for the number of people in your household.