Client Intake Form Food Bank Page 2

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Client Intake Form
age, sex and disability. To file a complain of discrimnation, with USDA, Director, Office of Adjudication and Compliance, 1400 Independence Avenue, SW, Washington,
D.C. 20250-9410 or call 202-260-1026, 1-866-632-992 (toll free) or 1-202-401-0216 (TDD)l
* All FBGC Partner Agencies are required to use this intake form.

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