Metrocrest Services does not share or report personal information.

Metrocrest Services provides help to people who live in Addison, Carrollton, Coppell, Farmers Branch, and the city of Dallas in Denton County (ZIP code 75287). Additionally, we serve any family who have children in Carrollton-Farmers Branch ISD and Coppell ISD.

Yes, I understand

Due to USDA Guidelines, you are not required to provide identification to receive emergency food services. However, I understand that by providing all the information in this application, I may be eligible for ongoing food pantry services.

Yes, I understand

Contact ID

Household Account ID

Food Assistance

How many persons live in your household?

Household Members

Please provide the names, birthdate and gender of all household members. Click on "Add another household member" to add more members.

First Name

Last Name

Birthdate

Gender

Relation

Minor/Adult

School

Name of Other School

Please upload a copy of this household member's ID.

DEP Counter

DEP Period

Calculated Field

calculated-all

Metrocrest Services does not share or report personal information.

Certifications

Nondiscrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

(1) mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410; or

(2) fax: (833) 256-1665 or (202) 690-7442; or
(3) email: program.intake@usda.gov.

This institution is an equal opportunity provider.

I certify that:

(1) I am a member of the household living at the address provided in Section 1 and that, on behalf of the household, I apply for USDA Foods that are distributed through The Emergency Food Assistance Program;
(2) all information provided to the agency determining my household’s eligibility is, to the best of my knowledge and belief, true and correct; and
(3) if applicable, the information provided by the household’s proxy is, to the best of my knowledge and belief, true and correct.

In consideration of the opportunity afforded me by Metrocrest, I hereby agree that I, my assignees, heirs, guardians, and legal representatives, will not make a claim against Metrocrest, or any of its affiliated organizations, or any of their board of directors collectively or individually, or the supplier of any materials or equipment that is used by Metrocrest, or any of the volunteer workers, for the injury or death of myself or damage to my property, however caused, arising from my participation with Metrocrest. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to myself, or damage to my property, sustained in connection with my participation in any program of Metrocrest.

I have read, understood, and agree to the policies described above as they relate to services provided by Metrocrest.

This institution is an equal opportunity provider.

Please type your name below to accept the terms above and sign the form.

Supplemental Nutrition Assistance Program (SNAP)	Temporary Assistance for Needy Families (TANF)	Supplemental Security Income (SSI)
National School Lunch Program (NSLP)	Medicaid	None