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How to Apply

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To apply for any Blessing Baskets’ Program, fill out the digital application form below or download and print the application and bring it to your appointment. You can also call the Blessing Baskets’ Office at (405) 215-9224.

 

Our office is located at 2725 Crossroads Boulevard, El Reno. Office hours are limited and by appointment only.​

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Qualifications

 

  • To qualify for the Families with Children Program, you must have one or more children living in the home.

  • To qualify for the Senior Monthly Grocery Program, you must be a senior citizen.

  • To qualify for any program, you must live in Canadian County west of Banner Road.

  • To qualify for any program, you must meet the TEFAP Income Guidelines below.

  • El Reno Blessing Baskets is an equal opportunity provider.

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2-1-1 Helpline
The 2-1-1- Helpline is a 24-hour crisis contact center that connects those in need to important local services and resources, including food assistance. It is free and confidential and operated by Heartline, a nonprofit based in Oklahoma City.

Intake Form | Application

Required

Required

Date of Birth/Fecha de Nacimiento:
Month
Day
Year

Required

Contact Information/Información de contacto

Required

Required

Required

Okay to contact/Autorization para contactar
Yes/Sí

Required

Okay to contact/Autorization para contactar
Yes/Sí
No phone/Sin telefono
Yes/Sí
What method of communication do you prefer?/Qué método de comunicación prefieres?

Please list each additional resident in the household address above./Por favor, enumere a cada residente adicional del domicilio indicado más arriba.

Person/Persona 1

Person/Persona 2

Person/Persona 3

Person/Persona 4

Person/Persona 5

Person/Persona 6

Is anyone in your household currently receiving SNAP? (formerly known as food stamps)/Alguna persona de su hogar está recibiendo SNAP? (Anteriormente conocida como cupones de alimentos o estampillas)
Yes/Sí
No/No
Please check the additional benefit programs the household is enrolled in, if any./Por favor, verifique los programas de beneficios adicionales en los que están inscritos en el hogar, si alguino:

TEFAP Proxy/Persona Apoderada para TEFAP:

Please list out the person(s) designated to sign for and receive food on your behalf/Por favor, indique la(s) persona(s) designada(s) para firmar y recibir los alimentos en su nombre.

What gender do you identify as?/Con qué género te identificas?
Female/Mujer
Male/Hombre
Transgender/Transgénero
None of these/Ninguno de estos
Prefer not to answer/Prefiero no responder
What is your race or ethnicity? (select all that apply)/Cuál es su raza o etnico? (Seleccione todas las opciones que correspondan):
Did you or anyone in your home, work full-time (30 hours or more per week), in the last month?/Trabajó usted, o alguien en su hogar, a tiempo completo (30 horas o más por semana) durante el último mes?
Yes, working 30 or more hours/Sí, 30 horas o más
No, not working 30 hours/No menos de 30 horas
Don’t know/No lo sé
Is there anyone in your household who cannot work because of disability?/Hay alguien en su hogar que no pueda trabajar debido a una discapacidad?
Yes, have disability/Si tiene una discapacidad
No, no disability/No ninguna discapacidad
Which category represents the total monthly income for your household?/Qué categoría representa el ingreso mensual total de su hogar?
$0 (zero/ cero)
Less than $500/Menos de 500
$500 - $999
$1,000 - $1,999
$2,000 - $2,999
$3,000 - $3,999
$4,000 or more/o más
Don’t know/No lo se
Have you, or anyone who lives with you, served in the U.S. military?/Has servido, o alguien que vive con usted, en las fuerzas armadas de los Estados Unidos?
Yes, on active duty in the past, but not now/Sí, estuve en servicio activo en el pasado, pero ya no
Yes, now on active duty/Sí, ahora estoy en servicio activo
No, never on active duty except for basic training/No, nunca en servicio activo, excepto durante el entrenamiento básico
No, never served in U.S. military/No, nunca serví en el ejército de los Estados Unidos
Does anyone in your household have any of these dietary restrictions? (Select all that apply)/Algún miembro de su hogar tiene alguna de estas restricciones alimentarias? (Seleccione todas las que correspondan.)
How true is this statement for your household? In the past 30 days, we were worried that our food could run out before we had money to buy more./Qué tan cierta es esta afirmación para su hogar? En los últimos 30 días, nos preocupó que se nos acabara la c
Often true/Cierto con frecuencia
Sometimes true/Cierto a veces
Never true/Nunca es cierto
Don’t know / Prefer not to answer/No lo sé / Prefiero no responder

Data Sharing with Third Parties Acknowledgement:/Reconocimiento sobre el intercambio de datos con groupos terceros:

To improve our programs and connect you with additional services, we may need to share your personal information with third parties, such as healthcare providers, social service providers, and our other partners. We will not deny you services based on your answer./Para mejorar nuestros programas y conectarle con servicios adicionales, es posible que necesitemos compartir su información personal con terceros, tales como proveedores de atención médica, proveedores de servicios sociales y

otros de nuestros socios. No le negaremos servicios basándonos en su respuesta.

Data Sharing
I agree to share my personal information with third parties./Acepto compartir mi información personal con groupos terceros.
I do not agree to share my personal information with third parties./No doy mi consentimiento para compartir mi información personal con groupos terceros.

TEFAP GUIDELINES

Family Size

1

2

3

4

5

6

7

8

For each additional family member, add:

Monthly Income

$2,660

$3,607

$4,553

$5,500

$6,477

$7,393

$8,340

$9,287

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+$947 per additional person

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