Emergency Pantry Application

Please complete this brief form to request services. You must live in Cedar, Clinton, Muscatine, or Scott County in Iowa.
If you have young ones and are in need of diapers, you can apply for free ones using the form below. We’ll be in touch soon after your submission.
* Indicates required fields
Contact Information
*
*
*
*
*
Address
Are you homeless?*
*
*
*
*
*
Additional Household Members
Please enter the following information for all of the additional individuals living in your household.
Member 2
*
*
*
*
Member 3
*
*
*
*
Member 4
*
*
*
*
Member 5
*
*
*
*
Member 6
*
*
*
*
Member 7
*
Middle Name
*
*
*
Member 8
*
*
*
*
Income
You may not apply for diapers if you are over income, but you may still apply for food.
Household Size Annual Income
1 $25,760
2 $34,840
3 $43,920
4 $53,000
5 $62,080
6 $71,160
7 $80,240
8 $89,320
Self-Declaration of Income
*
Needs
Food boxes provide about 48 hours of food per person. This is a free service open to anyone who needs it. After you receive your food, if you need food again in a few days, you can come back here and request more. If you request delivery and you are not at home, we cannot leave food that requires refrigeration.
Please indicate your need*
Diapers
We cannot honor requests for specific brands of diapers, and we cannot provide pull-ups. We will include baby wipes with diaper deliveries. You can come back here to request diapers weekly if you need them.
*
Pick-up
You can pick your food up Monday through Friday from 8:00 to 4:15 at our Davenport Office (500 E. 59th Street, Davenport IA 52807). You do not need an appointment. You can pick your food up immediately after submitting this request.*
Other Notes