Step 1 of 3 33% Participation requirements confirmationConfirmation(Required) Your income must not exceed 185% of the poverty level for Hawaii.Head of Household MemberName(Required) First Middle Last Email(Required) Username(Required) Password(Required) MobileBest way to contact you? Email Mobile Address(Required) Street Address ZIP / Postal Code GenderMaleFemaleOtherDate of Birth(Required) MM slash DD slash YYYY Disabled(Required)YesNoAnyone in the household employed?(Required)YesNoAnyone in the household receiving government assistance?(Required)YesNoVeteran(Required)YesNoStudent(Required)YesNoFirst Visit to The Pantry(Required)YesNo SurveyWithin the last 12 months, were you worried whether our food would run out before we got money to buy more(Required)YesNoWithin the last 12 months, the food we bought just didn’t last and we didn’t have money to get more(Required)YesNoHas your family been impacted by COVID-19?(Required)YesNo Household InformationHousehold Size(Required) 1 2 3 4 5 6 7 8 Heads of Households(Required) 1 2 Number of Adults in Household(Required) 1 2 3 4 5 6 7 8 Number of Children in Household(Required) 0 1 2 3 4 5 6 7 8 Ethnicity of Household MembersHispanic(Required) 0 1 2 3 4 5 6 7 8 Non-Hispanic(Required) 0 1 2 3 4 5 6 7 8 Race of Household MembersWhite European or Caucasian(Required) 0 1 2 3 4 5 6 7 8 Native Hawaiian(Required) 0 1 2 3 4 5 6 7 8 Pacific Islander(Required) 0 1 2 3 4 5 6 7 8 Asian or Asian-American(Required) 0 1 2 3 4 5 6 7 8 Black or African-American(Required) 0 1 2 3 4 5 6 7 8 Latino, or Latin American(Required) 0 1 2 3 4 5 6 7 8 Puerto Rican(Required) 0 1 2 3 4 5 6 7 8 American Indian or Alaskan Native(Required) 0 1 2 3 4 5 6 7 8 Mixed Race(Required) 0 1 2 3 4 5 6 7 8 Other Ethnicity of Family(Required) 0 1 2 3 4 5 6 7 8 SeniorsSeniors (Age 62+)(Required) 0 1 2 3 4 5 6 7 8 Health Concerns for the householdMentally Disabled(Required) 0 1 2 3 4 5 6 7 8 Physically Disabled(Required) 0 1 2 3 4 5 6 7 8 Other(Required) 0 1 2 3 4 5 6 7 8 EmploymentEmployed(Required) 0 1 2 3 4 5 6 7 8 Unemployed, not in school(Required) 0 1 2 3 4 5 6 7 8 Household VeteransYes(Required) 0 1 2 3 4 5 6 7 8 No(Required) 0 1 2 3 4 5 6 7 8 Students & ChildrenFull-Time Students in Family(Required) 18 Years Or Older Names First Section Break Family Size Income 1 $27,158.00 2 $36,686.00 3 $46,213.00 4 $55,740.00 5 $65,268.00 6 $74,796.00 7 $84,323.00 8 $93,851.00 Post BodyUntitledFirst ChoiceSecond ChoiceThird ChoiceConsent(Required) I agree to the privacy policy.
