The National Hunger Clearinghouse

Database Form

To be included in the National Hunger Clearinghouse, please complete the following database survey form.

PURPOSE

The National Hunger Clearinghouse is administered by World Hunger Year (WHY) under contract from the U.S. Department of Agriculture's Food and Nutrition Service. The purpose is to foster connections and information sharing among thousands of groups working on hunger, food, nutrition and other agricultural issues by compiling information in one central location. To accomplish this, the Clearinghouse is asking organizations and businesses to fill out this simple database form. Information from this form will be entered into the Clearinghouse's national database and will be available free of charge by phone, fax, or the Internet. Because of the diversity of organizations, all categories may not apply to your group.

INSTRUCTIONS

  1. If you're using Web browsing software capable of handling forms, the information you enter into the spaces below will be sent to us by email when you click the Submit Form button at the bottom of this page.
  2. Complete all questions relevant to your organization. You may have multiple entries in a category.
  3. Take as much space as you need to explain your program or mission in the last entry block.
  4. Send additional information about your organization -- brochures, publications, fact sheets, newsletters, etc. -- by postal mail; our address is listed at the end of the form.
  5. Add the National Hunger Clearinghouse to your mailing list and fax list.
  6. Return the form by clicking Submit Form below after you've filled in all the blocks.

OMB Control No. 0584-0474
Approval Date: 02/07/2000
Expiration Date: 02/28/2003

 
  Organization Name:    
  Street Address:    
       
  City:    
  State: Zip: Zip+4:  
  Phone: ( ) -  
  Fax: ( ) -  
  Salutation:
(Mr./Mrs./Ms./Dr./Etc.)		  
  First Name:    
  Last Name:    
  National, State or Regional Affiliation (optional):    
  E-Mail Address:    
  WWW Address:    
SECTOR (check all that apply):
  Nonprofit Other Commercial/Business Government Indian Reservation
TYPE OF ORGANIZATION (check all that apply):
  Direct Service Cooperative Educational Coalition Religious  
  Labor Association Network Funder Incorporated  
AREA SERVED (check all that apply):
  Urban City Rural County Suburban  
  State Regional Neighborhood National International
FOOD DISTRIBUTION (check all that apply):
  Food Bank Food Rescue/Gleaning Transportation/Trucking  
  Food Pantry Farmers Market Nutrition Program TEFAP  
  Warehouse Commodities/Food Donation Other  
PREPARED FOODS (check all that apply):
  Soup Kitchen School Lunch Group Meals  
  School Breakfast Meals on Wheels Summer Feeding  
  Kids Cafe Other Programs Café (Nonprofit)  
  Commercial/Business After School    
FOOD PRODUCTION and PROCESSING: (check all that apply):
  Farm   Processor   Community Garden  
  Packer Manufacturer Other  
    Type: (check all that apply):
    Family Owned Sustainable Agriculture  
    Hydroponics Organic  
    Aquaculture Land Trust/Land Link  
    Community Supported Agriculture Other  
FOOD SALES (check all that apply):
  Farmer's Market Wholesaler Terminal Market  
  Food Coop Neighborhood Market Food Buying Club  
  Grocery Store/Supermarket Prepared Food Other  
GLEANING and FOOD RESCUE: (check all that apply):
 Type of Food:
  Prepared Food   Produce   Fish/Meat  
  Dairy Other    
    Source of Food: (check all that apply):
    Restaurant Processor  
    Farm/Orchard Food Store  
    Caterer Packer  
    Farmers' Market Cafeteria/Food Service  
    Hotel Manufacturer  
    Wholesaler Other  
    Hospital    
ADVOCACY/POLICY/RESEARCH (check all that apply):
  Food Hunger Farm  
  Food Security Labor Legislation  
  Agriculture Hunger Hotline Sustainable Agriculture  
  Food Systems Grass Roots Organizing Economic  
  Nutrition Poverty Welfare  
  Other Homelessness    
EDUCATION (check all that apply):
  Agricultural Team Nutrition Academic/Continuing Education  
  Budgeting/Shopping Cooking/Culinary/Food Preparation Food Handling/Safety  
  Nutrition Menu Planning/Recipes Job Training/Vocation  
  Other After School    
SERVICE SITES (check all that apply):
  School (Preschool-12) Child Care Center Correctional Facility  
  College/University Community Center Religious Institution  
  Extension Service Organizational Offices Shelter  
  Public Housing Business Soup Kitchen  
  Health Care Facility Reservation Home/Residence  
  Other      
OTHER PROGRAM AREAS (check all that apply):
  Emergency/Disaster Assistance Family Services Community Development  
  Children/Teens/Youth International Assistance Homeless  
  Personal Services Economic Development Women  
  Arts/Culture Housing Legal Services  
  Health Care Seniors Environment  
  Low-Income Financial Services Substance Abuse  
  Gay/Lesbian Employment Literacy  
  HIV/AIDS Disabled Other  
FULL-TIME STAFF:
  None 1-9 10-24    
  25-49 50-99 100+    
  YEAR FOUNDED:    
  NUMBER of VOLUNTEERS:    
Do You Need Additional Volunteers:
  Yes No      
Do You Offer Internships?
  Yes No      
ANNUAL BUDGET:
  $0 - $49,999 $50,000 - $99,999  
  $100,000 - $499,999 $500,000 - $999,999  
  $1,000,000+  
Are You Willing To UPDATE Your Clearinghouse Information Annually?
  Yes No      
Do You Own A Computer?
  Yes No      
  Please attach a one-paragraph description of
your organization's mission and/or programs.
 
  Also, please mail us additional literature
(brochures, newsletters, etc.), and add
the Clearinghouse to your mailing list.

The National Hunger Clearinghouse is made possible by a contract administered by the Food and Nutrition Service of the United States Department of Agriculture. For further information please contact the Clearinghouse:

USDA National Hunger Clearinghouse at World Hunger Year
505 Eighth Avenue, 21st Floor * New York, NY 10018-6289
Phone: 1-800-GLEAN-IT or (212) 629-8850 * Fax: (212) 465-9274
Clearinghouse Email: NHC@WorldHungerYear.Org
World Wide Web: www.worldhungeryear.org/nhc

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0474. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing the burden, to the U.S. Department of Agriculture, Clearance Officer, OIRM, Ag Box 7630, Washington, D.C. 20250.

Form FCS-543 (5-96)