Community Resource Point — Lead Capture

Public lead capture

Street Lead Form

Capture a quality lead for the SCN Food Program.

Only submit a person who is genuinely interested in food/nutrition services, provides a working phone number, and agrees that our office may call or text them to complete eligibility verification. Do not collect names just to increase the lead count.

Section 1 — Contact Information

First Name *

Last Name *

Cell Phone Number *

Confirm Cell Phone Number *

Alternate Phone Number

ZIP Code *

Preferred Language *

Section 2 — Contact Preference

Best Time for Our Office to Call *

Can our office text this cell phone number? *