Become a Member

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Welcome to Sacred Heart Community Service

You can use this form to apply for food services from Sacred Heart.

Please use your cell phone with camera to fill this form out. Before beginning, take a picture of your photo ID showing your name, your birthdate and a picture of you. When you have those pictures ready, please fill out the form below.

Fill the form out completely and be sure to click on the Submit button when you are done.

First Name

Last Name

Birthdate (month/day/year)

Gender

Are you Hispanic, Latino or of Spanish Origin

Zip Code

We need either your email address or your cell phone number.

Phone or Email is Required

Phone

May we send a text messages to this phone number confirming your application?

YesNo

Please use this section to add additional members of your household

I would like to add additional members of my household.

First Name

Last Name

Birthdate

Please include identifications for primary and additional members.

Adults (18 or over): Photo ID with name and full date of birth for each adult.

Children age 17 and under: Medical card with name and full date of birth OR a birth certificate OR immunization card OR passport for each child

Be sure to click SUBMIT at the end of this form when you are done.

Phone/Email Check Section

Phone/Email Check

Contact Information