Shelf Stable Food Box Signup Shelf Stable Food Box Signup Though it is a new year, COVID-19 continues to negatively impact LGBTQ Houston. Having enough food is a prime struggle for many in our community. The Montrose Center wants to help meet that need as much as possible! Please complete this sign-up form to determine eligibility for receiving a shelf stable food box. If you are eligible and supplies are available, a Montrose Center staff member will follow up with you to confirm a pickup time. Chosen Name* First Last Email* Phone*Pronouns*She/Her/HersHe/Him/HisZe/Hir/Zirs/HirsThey/Them/TheirsJust Use My NameAre you currently struggling to buy enough groceries for your household?* Yes No Are you currently experiencing homelessness?* Yes No Demographic InfoThe questions in this section are optional, but your answers could help us get more support in the form of grants or other donations for the food pantry program. Answering these questions does not affect your eligibility to receive food.How many adults (18 or over) live in your household?012345More than 5How many children (under 18) live in your household?012345More than 5Gender IdentityTransgender WomanTransgender ManTransgender Non-Binary PersonCisgender Woman - AllyCisgender Man - AllyGenderqueer/Gender Non-ConformingAgender/BigenderIntersexPangenderI don't knowOtherSexual OrientationAsexualBisexualGayLesbianPansexualQueerQuestioningHeterosexual/StraightI don't knowOtherEthnicity: Are you of Spanish/Latinx origin?YesNoDecline to AnswerIf yes to the above, which of the following best describes you?Mexican, Mexican American, Chicano/aCubanPuerto RicanOther/Multi-Hispanic, Latinx, or Spanish OriginDecline to AnswerRaceAmerican Indian or Alaskan NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhiteOtherYour Food Pickup PreferencesHow do you plan to pick up your items?* I want to choose each item that goes in my food box during my pickup time. I want to receive a prepared box with 5 to 6 days' worth of food. What day of the week do you prefer to pick up your box of food? Monday Tuesday Wednesday Thursday Friday I need another option. What time of day do you prefer to pick up your box of food? Mid Morning (8 to 10am) Late Morning (10am to 12pm) Early Afternoon (12 to 3pm) Late Afternoon (3 to 5pm) I need another option. Do you have any special dietary restrictions we should consider? Vegan/Vegetarian Diabetic/Low Carb/Low or No Sugar Celiac Disease/Gluten Free Low Sodium I need another option. We will accommodate your needs to the best of our ability based on the supply of foods currently in our pantry.