I. AGENCY INFORMATIONAgency Code - Name*--- Select Code - Name ---AA00100 Allen AME Church (Edisto)AA01000 Ansonborough HouseAA01002 Park Circle CaresAA01700 Abiding Word Family MinistriesAA02200 Aldersgate United MethodistAA06000 Antioch Educational CenterAB00800 Bethel AME Church (Ridgeville)AB00900 Bethel AME RavenelAB01300 AMI Kids BeaufortAB01600 Bethel United Methodist ChurchAB02900 Buck Creek Baptist ChurchAB03100 Bethel Deliverance TempleAB04200 Berkeley Church of ChristAB04300 Bethel Outreach MinistriesAB04400 Bethel Pentecostal Holiness #3AB04500 Bethel AME Church Auxiliary 7AB05200 Bacon's Bridge Free Worship CenterAB05400 Bluffton Self HelpAB05600 Bethera Worship CenterAC00100 The Chosen One MinistryAC00200 Calvary AME ChurchAC00300 Chisom Housing Group - Colleton HeightsAC00400 Churches Assisting PeopleAC00600 Charleston Area Senior CitizensAC00700 Church of the CrossAC00900 New Beginning Outreach (DOC)AC02200 Community Kitchen of Myrtle BeachAC02400 Creative Church Food PantryAC02500 One80 PlaceAC03200 Celebration StationAC03800 Christ Temple of SummervilleAC04000 Cedar Grove Missionary BaptistAC04600 Charity Inspirational ChurchAC05400 Cathedral of PraiseAC05500 Canaan Missionary BaptistAC05900 Chesterfield Misshionary Baptist ChurchAC06100 Caring & SharingAC06300 Countryside Hunger Strike ProjectAC06900 Cherry Hill Missionary Baptist ChurchAC07200 Faith Outreach Ministries of the Grand StrandAC07300 Charleston Jewish Family ServicesAC07500 The Joshua GroupAC07900 Crossway Baptist ChurchAC08000 Community Resource Center SummervilleAC08002 Community Resource Center North CharlestonAC08500 Catholic Charities of the Pee DeeAC08600 Coastal Catholic CharitiesAC09000 Community Bible Church of BeaufortAC09200 Cordesville First BaptistAC09300 Carolina Youth Development CenterAC09302 Carolina Youth Development Center Moncks CornerAC09900 Church of Jesus Christ/ I AM MinistriesAC10000 Church of the HarvestAC11000 Calvary Baptist ChurchAC12000 Canaan M.B.C.AC20000 Church House MinistriesAC21000 Charleston Recovery CenterAD00400 Dorchester Seniors Inc.AD00500 Deer Park Baptist ChurchAD00700 Dogwood Hill Baptist ChurchAD00800 Dream CenterAD01200 Doda BabyAD02100 Deliverance Ministries OutreachAD02102 Deliverance Ministries Outreach #2AE00200 East Cooper Community OutreachAE00600 Emanuel AME Church West AshleyAE00800 True Faith Holiness ChurchAE01200 Ebenezer Missionary Baptist ChurchAE01300 East Cooper Meals on WheelsAE01400 Edgewood Baptist ChurchAE01500 Ebenezer AME Church - LincolnvilleAE01600 Eagle Harbor RanchAE01900 Evening of PrayerAE02000 El Shaddai Missionary BaptistAE02100 Ebenezer AME ChurchAE02300 Enoch Chapel and Methodist ChurchAF01000 Free Born Deliverence TempleAF02700 First Baptist Church of Mt. PleasantAF02600 First Euhaw Baptist ChurchAF03000 Faithworks MinistriesAF03100 Faith in ActionAF03800 Wither's Swash Park MinistryAF05300 First Zion Missionary BaptistAF05400 FBC Foundation James IslandAF05600 First Estill Baptist ChurchAF05700 Father's Cup Community PantryAF05800 Faith Assembly Moncks CornerAF05900 Favor Ministries OutreachAF06405 Fanning the FlameAG00200 Greater Goodwill AMEAG00400 Grace Alive - Jefferson Memorial CenterAG00500 Grays Hill Baptist ChurchAG00600 AMIKids Georgetown Inc.AG00700 Greater New Hope A.M.E.AG00900 Agape Family Life CenterAG01400 Greater Saint Paul AMEAG02300 Grace Reformed EpiscopalAG02600 Greater Cherry Grove ChurchAG03300 Gethsemane Cathedral of PraiseAG03900 Green Sea Baptist ChurchAG04200 Greater Mt. Ararat AME ChurchAG04500 Greater Gordon Chapel AME ChurchAG08000 Gateway Open ArmsAG08800 Greater St. Mark AME ChurchAG09500 Great Present AMEAG10100 Georgetown County CoalitionAH00200 Harvest Church Green SeaAH00400 Shoreline Behavorial HealthAH00500 Church of the Holy CommunionAH00600 Healing Waters Mission and Wellness CenterAH01100 Hilton Head Island Deep WellAH01300 Holy Cross Faith Memorial Episcopal ChurchAH01400 Helping Hands of GeorgetownAH01500 Helping Hands of Goose CreekAH01600 Helping Hand of Myrtle BeachAH01900 Help of BeaufortAH02300 Hopewell AME Church, Inc.AH02400 Hebron Zion PresbyterianAH02600 Lowcountry Mgmt. Service Inc.AH02900 Holy Family Catholic ChurchAH03400 Hopewell CME ChurchAH04600 Huspah Baptist ChurchAH04800 House of Prayer and PraiseAH05200 Margaret F. Curtis Food PantryAH05400 Heart for Humanity, Inc.AH05700 Heart to Heart BerkeleyAH05800 Humanities Foundation West AshleyAI00400 Immanuel Reformed Episcopal ChurchAI01400 Iglesia Luz y VerdadAJ00015 Jehovah AMEAJ00100 Jesus Changes People MinistriesAJ00200 Jenkins Orphanage InstituteAJ00700 Joshua United Methodist ChurchAJ01100 James Island OutreachAJ01200 Jasper County Hunger Free ZoneAJ01700 Jehovah TabernacleAJ02000 Juniper Bay Baptist ChurchAJ02300 Jehovah UMAJ02400 Jerusalem Baptist ChurchAK08700 Knightsville UMCAL00200 Life House ChurchAL00300 Faith Assembly of God - RemountAL00400 Palmetto Community CareAL00500 Lowcountry Community Action Agency, Inc.AL00600 St Luke Holiness COGICAL01600 Tricounty Family MinistriesAL02100 The Father's HouseAL04400 Line Street Church of GodAL04500 Light MinistriesAM00500 Metropolitan Community ChurchAM00600 Moncks Corner Community SKAM00605 Mt. Pleasant Booster ClubAM00700 Mercy Mission/Catholic CharitiesAM01100 Mt. Moriah Missionary BaptistAM01300 Mt. Zion United Methodist ChurchAM01400 Mt. Olive Baptist CHSAM01500 Mt. Olive Baptist WalterboroAM01700 Meals On Wheels, SummervilleAM01800 Lowcountry C.A.R.E.SAM02400 Murray United Methodist ChurchAM02500 St. Mark Bloomingvale CDC, Inc.AM05100 Mt. Olive Baptist ChurchAM05400 Moncks Corner 7th Day AdventistAM06000 Mt. Sinai Baptist - HamptonAM06200 Mt. Nebo Baptist Church IIAM06300 Mt. Calvary #2 MBCAM06400 Windows of Heaven MinistryAM06500 Ministry of Hope & ReconciliationAM06600 MMM Community CoalitionAM06700 Murrells Inlet Church of GodAM06800 Mental Health America - SCAM07000 Monte CalvarioAM07200 Miracles Are Happening NowAM07300 Morris Street Baptist ChurchAM07500 Mt. Carmel United Baptist ChurchAM08800 Mt. Sinai Missionary Baptist ChurchAN00400 New Beginnings of CharlestonAN00500 New Bethel Sounds Of PraiseAN00700 New Cannon St Baptist ChurchAN00800 National Action NetworkAN00900 New Francis Brown U.M.C.AN01100 Neighborhood HouseAN01800 North Strand Helping HandAN04500 New Life Deliverance TempleAN04700 New Abundant Life ChurchAN04900 New Hope UME ChurchAN05000 New Israel RE ChurchAN05200 New Light UMCAN05500 New Covenant Church of GodAO00900 Our Lady Of Mercy Community OutreachAO01200 Christian Mission OutreachAO01800 Ocean Grove United MethodistAO01900 Olive Branch AMEAP01400 Pine Grove Baptist ChurchAP02300 Praise Tabernacle ChurchAP03000 Precious Blood of ChristAP03200 Pointe North ChurchAP03600 Praise Assembly of GodAP03700 Presbyterian Church of Edisto IslandAP04100 Phi Theta KappaAR00500 Rehoboth Full Gospel MinistryAR00600 Royal Baptist ChurchAR00700 Rosemont Community Senior CitizensAR01100 Ridgeville Community Resource CenterAR01500 Refuge TempleAR01800 Resurrected Church of JesusAR01900 Redeemer R.E. ChurchAR02000 Ryan White Wellness CenterAR07000 Charleston Community ImpactAS00020 Santee Circle Community ChurchAS00030 Shifa ClinicAS00100 Salvation Army/N. CharlestonAS00500 Salvation Army of GeorgetownAS00600 Salvation Army of BeaufortAS00700 Upper Dorchester Community MinistriesAS00800 Soldiers' AngelsAS00900 St. Anthony's Catholic Church Helping HandsAS01000 Salem Baptist ChurchAS01800 St. Jude Apostolic Faith ChurchAS02000 St. Timothy's ChurchAS03200 New Directions of Horry CountyAS03300 St. Peter Missionary Baptist ChurchAS03400 St. Stephen Baptist ChurchAS03700 Shady Grove United MethodistAS03800 St. Stephen Seventh Day AdventAS04100 St. Delight Community OutreachAS04700 The Special GatheringAS05700 Shiloh Seventh Day AdventistAS06100 Comm. Center of St. MatthewsAS06400 Solomon Temple Church of GodAS06900 South Strand Helping HandsAS08000 St. James Bethel A.M.E.AS08300 Sea Haven Inc.AS08800 Shield Ministries, Inc.AS09600 St. Stephen UM OutreachAS09700 Sea Islands Blessing BasketAS10400 South Santee Community CenterAS10800 Seacoast - SummervilleAS11700 St. Vincent DePaul SocietyAS11800 St. John Community Food MinistryAS12000 Delancey StreetAS12100 Seacoast - West AshleyAS12300 Fellowship Food BankAS12600 Second Chance RecoveryAS13000 St. Elizabeth Missionary Baptist ChurchAS13100 Sandalwood Community Food PantryAS13700 St. Joseph Missionary BaptistAS13900 St. Barnabas Lutheran ChurchAS14000 St. Paul MBC/ConwayAS14600 Springtown United MethodistAS17000 Feeding of the MultitudesAS17200 Shepherd of the Sea Lutheran ChurchAS18000 St. Pauls SummervilleAT02900 Teachings From The ArkAT03100 Take it to the StreetsAT03200 The Shepherd's TableAT03300 Tabernacle of MeetingsAT03400 Trueway Baptist ChurchAT03600 Tri-County Veterans Support ServicesAT03800 Teen Challenge of South CarolinaAT04500 The Refuge at FPHCAT04800 True Vine Christian FellowshipAT05200 Trident Area Agency on AgingAU00100 Union Baptist ChurchAU00600 United Community Food BankAV00700 Vanderhorst Koinonia MinistriesAW00100 Wesley AME/Jehovah HolinessAW00300 Waccamaw BaptistAW00500 Hollywood CoalitionAW00502 Wesley UMC/HollywoodAW01500 Wallingford Presbyterian ChurchAW01800 Waccamaw Youth Center Inc.AW02600 World Harvest of HamptonAW02700 World Harvest MinistriesAW02800 Wesley UM SummervilleAW03100 Westminster PresbyterianPlease go back to the last question and select a different agency code* Please go back to the last question and select a different agency code Agency County*--- Select County ---BeaufortBerkeleyCharlestonColletonDorchesterGeorgetownHamptonHorryJasperWilliamsburgPlease go back to the last question and select your agency's county.* Please go back to the last question and select your agency's county. Services Provided for the month of*--- Select Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberPlease go back to the last question and select the appropriate month.* Please go back to the last question and select the appropriate month. Services Provided for the year of*20192020II. ON-SITE FEEDING PROGRAMS(ONLY agencies that prepare cooked meals should complete this section)Total number of meals served this monthIII. FOOD PANTRIES and SAME DAY DISTRIBUTION SITESTotal number of households served this monthTotal number of individuals served this monthIV. AGENCIES RECEIVING USDA COMMODITIESTotal number of households receiving USDA commodities this monthTotal number of individuals receiving USDA commodities this monthV. AGE OF CLIENTS SERVEDChildren (0-17)Adults (18-59)Seniors (60 plus)TotalVI. POUNDS RECEIVED FROM SOURCES OTHER THAN THE LCFB(Enter pounds received from food donations, grocery store purchases, a food drive you hosted, garden/farm produce, etc.) Note: This does NOT include RPA pounds. Beaufort, Hampton, and Jasper County agencies – please do NOT enter pounds received from Second Helpings.Total pounds received from other sourcesWellness Pantry ReportingAre you a designated LCFB Wellness Pantry?YesNoFind out more about becoming a Wellness Pantry How many people did you reach with the nutrition education toolkit?Which lesson did you complete? Check all that apply. Blubber Burger Sugar Overload Recipe sampling Label Lingo How many nutrition handouts were distributed? (i.e. MyPlate Tips, Eat Well Be Well, recipes, etc.)What activities did you complete in the service month? Select all that apply. Distributed produce Provide health related information Hosted a wellness check Shared SNAP information Other What other activity did you complete?Reporter's InformationNameEmail I certify that the above information is correct*Yes This iframe contains the logic required to handle Ajax powered Gravity Forms.
