Application for Soup Mix and Apple Chips



2019 Application for Vegetable Mix and Fruit Snacks

Ontario Christian Gleaners Tel: 519-624-8245

1550 Morrison Rd. Cambridge ON N1R 5S2 Fax: 519-624-4519

E-mail: manager@

Website:

Important: Complete application form on computer. Remember to save and send as an attachment.

Attach Audited Financial Statements

Email all information to fdc@

|Date: | |

|Name of Organization: | |

|Charitable Number: | |

|Address: | |

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|City: | |Prov. / State: | | | |

|Post/Zip Code: | |Telephone: | |Fax | |

|Website: | |E-mail: | |

|Contact: | |Title: | |

What is your request? (1 bag of vegetable mix makes roughly100 cups, when cooked in 25 litres of water.) Please specify the qty of bags or drums / pails

|Bags of Vegetable Mix: | |Bags of Fruit Snacks: | |

|Drums of Vegetable Mix: (55 | |Drums of Fruit | |Plastic Pails? (4 bags) | |

|bags) | |Snacks: (55 bags) | | | |

|When would you plan to ship? | |

|Do you have the required funds in place to cover shipment? | |

|Where is this food going? (city and country) | |

|In what manner will our donation of dehydrated Vegetable Mix affect | |

|(hurt/help) the local economy of the recipients? | |

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|What is your organization doing to reduce and eventually eliminate the | |

|need for food aid? | |

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|Is a Phytosanitary certificate required? | |

|Who is handling the cargo? | |

|How do you intend to fund the | Out of existing funds | |Through fundraising | |

|shipment? | | | | |

|How will it be distributed? | |

Who are the beneficiaries? (Please fill in the approximate number of people)

|Orphans: | |

|Name the mission organization, social institutions, | |

|hospitals, churches etc. that will receive the cargo | |

|Will you give PROMPT feedback to the Gleaners about suitability of product, improvements the Gleaners can make, and personal | |

|stories about someone who benefited from this cargo as well as how it will be distributed? | |

|Will you provide digital pictures / video? | |

|Have you received food from another Gleaners | |Which Gleaners? | |What Year? | |

|facility? | | | | | |

The applicant agrees that this product is a donation designated for use on Mission Relief and Development Projects only. It is not for sale, not for exchange, not for profit or gain, no commercial value. In signing this application the applicant releases the reports and photos for the Gleaners to be used as promotional material in their publications and on their web-page.

|Applicant Name: | |

|Signature: | |

|Date: | |

Organizations are requested to make arrangements for pick up within 30 days

|Earliest pick up date: | |Time: | |OCG Rep | |

Partner Information

It is important for the Ontario Christian Gleaners to know who is implementing the project. This section gives us some information on your organization and any experience with food and nutrition projects. It also helps us to understand your basic philosophy and approach to food security and nutrition.

You may use this form to provide the information or you may submit your own.

We would also like to receive a copy of financial statements of previous fiscal year (preferably audited)

|Brief history of your organization: | |

|(can paste info from your website) | |

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|Mission statement: | |

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|Mandate: | |

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|Project Details: | |

|- Name of project | |

|- Objectives | |

|- Background | |

|- Who is implementing this project | |

|- Duration of project | |

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|What role does the OCG food play in | |

|your program or project? | |

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|Your organization's previous | |

|involvement with food and nutrition | |

|issues: | |

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In addition to the above, you may wish to attach an organizational chart and/or recent annual report.

If you have any questions about this section, please contact the OCG Food Distribution Committee

fdc@ or Shelley Stone (519) 624-8245.

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