Nominate a Family or Individual in Need

First Name *

Last Name *

Current Location *

Number of People in Household *

Write a message *

Active Email Address

Contact Number

Who are you? *

Homeless person
Homeless family
ILF/housing operator
Case manager
Social worker
Community member
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What is your preferred means of receiving the meal donation? *

Visit to your location
Onsite meeting
Visit to ADF's facility
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