Homebound Delivery Order for 7/8/2020. Please complete by 7/6/2020 at 2:00 PM.

You must live in the South Lyon School District Area for Home Delivery. Delivery is limited to those homebound by medical necessity, those over the age of 60, those with immunocompromised family members, or lack transportation. In the interest in maintaining social distancing and following the recommendations of the CDC: the delivery person will place the items on your porch, knock or ring the bell and leave. The delivery person will not/cannot enter the home. All items requested are subject to availability as the list is always changing.
Check all items you wish to receive today.
Canned Tomato Products (Choose 1)
Soups (Choose 2)
Canned Fish (Choose 1)
Peanut Butter or Jelly? (Choose 1)
Canned Vegetables (Choose 3)
Canned Beans (Choose 2)
Dry Beans (Choose 1)
Canned Fruit (Choose 2)
Canned Meat (Choose 2) Subject to availability.
Please check all you wish to receive today.
Bread (Choose 1)
Cereal (Choose 1)
Juice (Choose 1)
Perishable items you wish to receive if they are available in the pantry.
Frozen Meat (Choose 1) if it is available in the pantry.
Fresh Produce (Check yes or no) You will be given a variety of what we have available. *
By submitting this form, I declare that I am either 1)in need of emergency food, OR 2)in a household where the income falls at or below the posted federal poverty guidelines listed below.
This institution is an equal opportunity provider.
This table shows a gross income for each household size
Based on 200 Percent Federal Poverty Income Guidelines
Household Size Annual Monthly Weekly
1 $25,520 $2,126 $490
2 $34,480 $2,873 $663
3 $43,440 $3,620 $835
4 $52,400 $4,366 $1,007
5 $61,360 $5,113 $1,180
6 $70,320 $5,860 $1,352
7 $79,280 $6,606 $1,524
8 $88,240 $7,353 $1,696
For each additional family member add $8,960 $746 $172