To register for the pantry, please fill out the form below. After filling out the form, you are welcome to start shopping at the pantry anytime during our pantry hours.

If you would like assistance filling out the form, you may come to the pantry during pantry hours and let us know you would like to sign up for the pantry, or you can schedule a quick needs assessment with a case manager for assistance.

You must be a Tolland Country Resident to utilize our Food Pantry Services.

Name *

First Name

Last Name

Authorization to receive emails. *

Select One

Yes

Phone Number *

(###)

###

####

Authorization to receive text alerts. *

Select One

Yes

Date of Birth *

Month/day/year format

Gender *

Race/Ethnicity *

Do you identify as an individual with mental or physical disabilities? *

This is a medical designation which can be used to better assist you while visiting our program.

Yes

Town of Residence *

Street Address *

Please include APT/Unit Number if Applicable

Do you have children between the ages of 0-5? *

Do you have children between the ages of 5-12? *

Do you have children between the ages of 13-17? *

What is the number of people aged 18-29 living in your household? *

What is the number of people aged 30-39 living in your household? *

What is the number of people aged 40-49 living in your household? *

What is the number of people aged 50-59 living in your household? *

What is the number of people aged 60 & older living in your household? *

Special Dietary Needs

Medically Documented

Food Allergies

Check all that apply.

Wheat

Nuts

Fish & Shellfish

Eggs

Soy

Sesame

Attesting Your Income - TEFAP FORM *

You are verbally confirming that the following information is true: You are a resident of the State of Connecticut. You are at or below the (yearly) gross income limit for the number of people in your household below: Household of 1- 31,937 Household of 2- 43,029 Household of 3- 54,121 Household of 4- 65,213 Household of 5- 76,305 Household of 6- 87,397 Household of 7- 98,489 Household of 8- 109,581

Yes, I attest that I meet the following income requirements.

No I do not, my income exceeds the federal guidelines outlined in the form.

How did you hear about our pantry? *

If you are a Case Manager/Social Worker or applying on another person/families behalf, please enter your contact information in the form field below.

If you are applying for yourself or your family, please leave this area blank.

Thank you! We look forward to seeing you in the pantry.

Welcome to our Food Pantry! We're here to offer support and assistance when it’s needed most.

Please note:

If you do not fall within the listed federal income guidelines in the form, this does not affect your eligibility for the Food Pantry overall. Clients that do not meet these guidelines should not take food items with a TFAP label on them. You are welcome to all other food in our pantry.

To view the full federal tefap form, please click here.

Stay in touch.

Food Pantry, Transportation and Administration
29 Naek Road Suite 5A
Vernon, CT 06066
860-872-7727 - Pantry and Administration
860-870-7940 - Transportation

Outpatient Clinic and Case management
27 Naek Road Suite 4
Vernon, CT 06066
860-872-9825
Norwich Outpatient Clinic
18 Oneco St Suite 2
Norwich, CT 06360
860-872-9825

Questions?