Because Metrocrest's food pantry is supported in whole or in part by financial assistance from the Federal Government, we are required to let you know that:
- We may not discirinate against you on the basis of religion or religious belief; a refusal to hold a religious belief; or a refusal to attend or participate in a religious practice;
- We may not require you to attend or particpate in explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization) that are offered by our organization, and any participation by you in such activitties must be purely voluntary;
- We must separate in time or location any privately funded explicitly religious activites (inclduing activites that involve overt religious content such as worship, religious instruiton or proselytization) from activities supported with direct Federal financial assistance; and
- You may report violations of the protections, including denials of services or benefits, by an organization, by contacting or filing a written complaint with the
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights Executive Director
Center for Civil Rights Enforcement
1400 Independence Avenue SW
Washington, DC 20250-9410, or by emial to program.intake@usda.gov
- If you would like to seek information about whether there are any other federally funded organization that provide these kinds of services in your area, please contact the USDA Hunger Hotline:
By Phone: 1-866-3-HUNGRY or 1-877-8-HAMBRE to speak with a representative from 7:00 AM - 10:00 PM Eastern Time.
By Text: 914-342-7744 with a question that may contain a keyword such as "food," "summer," "meals," etc. to receive an automated response to resources located near an address and/or zip code.
NOTE: You may also contact TDA at 877-TEX-MEAL (877-839-6325) or SquareMeals@TexasAgriculture.gov.
This written notice must be given to you before you enroll in the program or receive services form the program, unless the nature of the service provided or exigent circumstances make it impracticable to provide such notice before we provide the actual service. In such an instance, this notice must be given to you at the earliest available opportunity.
This institution is an equal opportunity provider.
Metrocrest Services operates in accordance with the US Department of Agriculture and Texas Health and Human Services Commission policy, which prohibits discrimination on the basis of race, color, sex, age, disability, religion, political belief, or national origin. Social Security numbers are not required in order to receive food, rental, and utilities assistance. Metrocrest Services has my permission to exchange information regarding my circumstances with other Human Service Agencies. I understand that information on this form may be verified. I understand that inappropriate behavior may result in loss of services.
I certify that:
- I am a member of the household living at the address provided and, on behalf of the household, I apply for USDA Foods that are distributed through The Emergency Food Assistance Program.
- All information provided to the agency determining my household’s eligibility is, to the best of my knowledge and belief, true and correct, and
- If applicable, the information provided by the household’s Authorized Representative is also, 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.