Monthly Statistical Report

Statistics are due by the 15th of each month for the previous month

Reporting for the month of

In the year of

Type of service: Select all that apply

Pantry Meal Site Shelter Supplemental

Pantry Statistical Report

Only complete this section, if your organization provides bags or boxes of food to low income households

Full or Partial Service

With Minor Children

Number of households

Number of Seniors Served
(Age 60 & older)

Number of Adults Served
(Age 18-59)

Number of Children Served
(Birth - 17)

Total Number of People Served

Without Minor Children

Number of households

Number of Seniors Served
(Age 60 & older)

Number of Adults Served
(Age 18-59)

Number of Children Served
(Birth - 17)

Total Number of People Served

Total

Total Households

Total Seniors

Total Adults

Total Children

Total People

Meal Site Statistical Report

Only complete this section, if your organization provides meals as a Soup Kitchen, a Shelter, or as supplemental service alongside primary service.

Head Count:

Count should be unduplicated. Once a person has been counted for the first time each month, any additional meals they received that month should not be included in this count.

Plate Count:

This count should be duplicated and represent every plate served in the month.

Submit Report