Community Member Intake Form

Please complete this form if this is your first time visiting Metro Caring.
We use demographic data primarily for reporting to our funders and for telling more accurate stories about how hunger affects different communities. Data is reported in aggregate, meaning your personal information (such as your name, address, or contact information) is never tied to the demographic information we share. For example, we might share that 50% of our community shopping in the market self-identified as Hispanic/Latine, but we will never share a list of names of shoppers.

Other information, such as contact information (email, phone number, address), is never shared outside of Metro Caring. We do not sell any information to other organizations or businesses for any reason.

In many cases, you may choose "Prefer not to say" to opt out of disclosing certain demographic information.

You can view our Privacy Policy here.

Contact Information

We ask the following demographic questions primarily to understand our community better and to tell more accurate stories to our funders. Data is reported in aggregate, meaning your personal information (such as your name, address, or contact information) is never tied to the demographic information we share.

Lenguaje preferido




¿Es usted un/a veterano/a?

¿Actualmente no tiene hogar?


¿Tiene un discapacidad?

Origen étnico

Raza (mantenga precionado la tecla CTRL para seleccionar más de una)

Género




Pronombres debemos utilizar para referirse a usted: He/Him/His = él, She/Her/Hers = ella, They/Them/Theirs = pronombres no binarios. Mantenga precionado la tecla CTRL para seleccionar más de una.

Metro Caring does not limit access to our services based on income or employment. Sharing your income and employment information will NOT impact your ability to access our Fresh Foods Market, ID Vouchers, nutrition classes, or other services.


Número de télefono
Dirección
Ciudad
Estado
Código postal
País

Marque esta casilla si desea que alguien se comunique con usted para compartir su historia (en publicaciones de blog, boletines, etc.)
 Additional Household Members
Primer Nombre
Apellido
Fecha de nacimiento (mes/día/año)
Please only share information that you are 100% sure is correct. If you don't know the information or don't feel comfortable answering these questions on behalf of someone else, please refrain from answering.

Lenguaje preferido


¿Es usted un/a veterano/a?

¿Tiene un discapacidad?



Origen étnico

Raza (mantenga precionado la tecla CTRL para seleccionar más de una)

Género




Pronombres debemos utilizar para referirse a usted: He/Him/His = él, She/Her/Hers = ella, They/Them/Theirs = pronombres no binarios. Mantenga precionado la tecla CTRL para seleccionar más de una.