Fill out our application form to receive a personalized $100 grocery delivery—completely free of charge. We want to make sure your family gets exactly what it needs, so please provide:

1. Contact & Location

   • Full name, phone number, and email address

   • Mailing address and ZIP code (so we can shop at a grocery store in your area)

2. Household Details

   • Number of adults and children in your household

   • Any special dietary needs or food allergies (e.g., gluten-free, dairy-free, nut allergies)

   • Cultural or religious food considerations (e.g., halal, kosher, vegan)

3. Favorites & Comforts

   • List up to five of your family’s favorite foods or beverages (snacks, fruits, drinks, etc.)

   • Any “comfort” or “treat” items you’d love to see in your box

4. Additional Notes

   • Briefly describe your current situation or need—this helps us prioritize families facing the greatest hardship

   • Preferred delivery instructions (e.g., leave at front door, ring bell)

Who Can Apply?
Any family in California or Nevada is welcome. Whether you live in a big city or a rural town, we’ll source your groceries locally to support your community’s businesses.

What to Expect:

• After you submit, our team will review your application within 1–2 weeks.

• We’ll shop, pack, and deliver a $100 grocery box straight to your door .

• All personal information is kept confidential and used solely for coordinating your deliveries.

Thank you for trusting Nevada’s Youth Gracious Givers. We’re honored to serve your family!