Food Bank

Last updated: Sep 15th 2021

Please use this form to request a food basket. We will assess the information and call you back to inform you if you are eligible.

• Only those called can pick up. We wish to offer everyone but we have limited resources
• For single mothers and disabled people, we might arrange for the basket to be delivered

When notified, recipients can pick up their baskets at:

1. Al-Madinah Center (1260 Mackay)
2. Sister Sabria Foundation (5271 St Hubert)

This project is done in collaboration with various organizations.

Priority is for: Single mothers, refugees without government support, seniors, students without parental support, and people with disabilities. Citizens /  PR on welfare are low priority unless they have a reason why they can not work.

Food Basket Request Form

First Name(Required)

Last Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code

Residency / Visa Status in Canada?(Required)

PR / Citizen

International Student / Visitor

Refugee / Asylum seeker

Do you work?(Required)

Yes

No

What is your monthly income?(Required)

If your monthly income is more than $2500 (including other jobs), you might not be eligible.

Are you on Welfare?(Required)

Yes

No

No but Retired (Pension)

How much welfare do you receive?(Required)

Why you do not work or why you do not have welfare?(Required)

How much pension do you receive?(Required)

Do you have a work permit?(Required)

Yes

No

Are you receiving government support?(Required)

Yes

No

How much gov support you receive?(Required)

When did you receive the immigration answer for your case?

MM slash DD slash YYYY

Upload status document

Drop files here or Select files

Accepted file types: png, jpg, pdf, Max. file size: 256 MB.

This can be a passport photo, provincial gov photo ID, immigration paper photo, visa photo ...

Why you do not reveice governemnt support if you have got a result and you are a refugee?(Required)

---

House Information

Own / Rent(Required)

Rent an apartment

Low income housing

Other situations

Explain what is your situation please. We respect your confidentiality(Required)

Monthly Rent(Required)

---

Marital Status

Marital Status(Required)

Not married

Married

Widowed / Divorved

Do you have kids living with you?(Required)

Yes

No

Number of kids younger than 16(Required)

How many 17 years or older?(Required)

Do you receive government support for children?(Required)

Yes

No

Why you do not receive government support for children?(Required)

Any Special case?

File

Drop files here or Select files

Max. file size: 256 MB.

Upload any proof that helps us determine your current eligibility for help.

Consent(Required)

I agree to the privacy policy.

Al-Madinah Center respects your confidentiality and will not share any personal information with a third part. Yet, we do reserve the right to cross check with other organizations in Montreal if help was offered to your household during the past few weeks.

All confidential information will be deleted from our systems once the application is assessed.

If you are eligible for continuous help (monthly or quarterly), we need to keep your information as long as we are offering help. Once the help stops, we remove your profile and data will deleted.

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Phone

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