Monthly Agency Survey Report
Contact Information Agency Name Site Address Phone
Contact Person Month January February March April May June July August September October November December Year 2006 2007
Pantry Sites Number of Families Served Number of People Served People Served Ages 0-5
Congregate Sites (complete only if you are a congregate site that prepares and serves meals) Number of Families Served Number of People Served Number of Meals Served People Served Ages 0-5
In the following section, enter the number of people you served in the zip code.
City of Fresno
City of Clovis
Rural Fresno County
Other Areas
Monthly Reports are due by the 5th of every month
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