Court Ordered Service - Food Bank of Northwest Indiana

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Court Ordered Service

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Select the type of offense from the list below *

Please specify

Name *

First

Last

Email *

Phone *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Have you ever been convicted of a felony? *

Yes
No

If you have been convicted of a felony, please describe the offense

Description Of Community Service

Name of Court *

City of Court *

State of Court *

Briefly explain circumstances of current offense *

Upload court documents

Click or drag files to this area to upload. You can upload up to 5 files.

Max. file size: 4 MB. Please Note: A copy of an official court document or copies of traffic tickets clearly detailing the nature of the offense in writing must be submitted. Paperwork that does not include the nature of the offense in writing and the name of the applicant will not be processed. UPLOAD A COURT DOCUMENT (4 MB LIMIT) *

Total number of hours to be completed *

Date hours were assigned by the court *

Date hours are due to the court *

Do you plan to complete all of your hours at the Foodbank of Northwest Indiana *

Yes
No

Upload a copy of your valid ID (State Issued ID, Driver's License, Passport, Etc.) *

Click or drag a file to this area to upload.

Max. file size: 4 MB.

Waiver to offense

General Information

Are you able to stand for a period of 3 or more hours? *

Yes
No

Are you able to lift up to 25 pounds *

Yes
No

Emergency Contact *

First

Last

Relationship *

Emergency Contact Phone *

Waiver & Release

Waiver & Release *

I hereby waive The Foodbank of Northwest Indiana, its officers, board and employees from any liability that may arise due to personal injury, loss or damage to personal property that may arise from volunteering for the Foodbank of Northwest Indiana or participating in a volunteer event. As a volunteer I understand that I am not covered under the insurance policies of the Food Bank of Northwest Indiana. I acknowledge that I understand the waiver described in this document. This waiver is made to the maximum extent permissible under applicable law. I have read and understand the waiver

Court Ordered Service Guidelines

Court Ordered Service Guidelines *

I have read and understand the community service guidelines and agree to abide by these guidelines for the duration of my time at The Foodbank of Northwest Indiana

The application must be completed with all questions fully answered. All court ordered community service must be approved prior to scheduling. Volunteers must abide by all Food Bank of Northwest Indiana general guidelines, safety rules, and dress code when volunteering. Attrition and unsatisfactory work can result in removal from the court ordered community service program.

6490 Broadway, Merrillville, IN 46410
219.980.1777
219.525.4043 fax
info@foodbanknwi.org

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The Food Bank of Northwest Indiana does not collect any personal information from this website. Food Bank of Northwest Indiana is a 501(c)(3) private nonprofit organization. ©2025 Food Bank of Northwest Indiana. In accordance with Federal law and internal policy, the Food Bank of Northwest Indiana is prohibited to discriminate in all its program and activities on the basis of race, color, national origin, age, disability and where applicable, sex, marital status, familial status, parental states, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or a part of an individuals’ income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact the Food Bank of Northwest Indiana CEO at 219-980-1777. The Food Bank of Northwest Indiana is an equal opportunity provider and employer.

The following percentages and dollar amounts of the total costs which will be financed with federal money: TEFAP (28%, $5,154,776) and CSFP (7%, $1,313,104). The percentage and dollar amount of the total costs of the project or program that will be financed by nongovernmental sources is 65%, ($12,144,804)

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