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More Than a Meal™

GAP Shopping Report

Please submit within 24 hours of shopping trip using the latest versions of Chrome, Safari, Firefox, or Edge. Questions? Email morethanameal@mowcm.org

    Fields with an asterisk * are required.


    Enter N/A if other form of payment (non-credit card) was used.



    Please enter each individual payment method amount and attach the receipt image.
    Is this a return? YesNo

    Receipt Date: (XX/XX/XXXX)

    Receipt Amount:
    Payment Method: If other, please explain:

    Attach receipt (please use one of the following file types: jpeg|jpg|png and be sure the file is less than 5MB.

    WERE TWO FORMS OF PAYMENT USED IN THE SAME TRANSACTION OR DO YOU HAVE MORE RECEIPTS TO ENTER?*

    Is this a return? YesNo

    Receipt Date: (XX/XX/XXXX)

    Receipt Amount:
    Payment Method: If other, please explain:

    Attach receipt

    Is this a return? YesNo

    Receipt Date: (XX/XX/XXXX)

    Receipt Amount:
    Payment Method: If other, please explain:

    Attach receipt

    Is this a return? YesNo

    Receipt Date: (XX/XX/XXXX)

    Receipt Amount:
    Payment Method: If other, please explain:

    Attach receipt

    Will the client check and/or receipt be mailed? YesNo

    Did you assist with putting food away? YesNo

    Did you help the client in another capacity? YesNo
    If yes, please explain:

    DO YOU HAVE A CLIENT CONCERN? YesNo
    If yes, please explain:

    Have you seen that your grocery client has made wiser food choices since they started the program? YesNo
    If no, please explain:

    Have you noticed that your grocery client is selecting more fruits and vegetables, or other healthy options? YesNo
    If no, please explain:

    My client always wants me to shop for:

    My GAP client appears to have enough food in the home: YesNo
    If no, please explain:

    My GAP client's home appears neat and in good repair: YesNo
    If no, please explain:

    My GAP client appears socially engaged and in good spirits: YesNo
    If no, please explain:

    Rate your overall experience as a Meals on Wheels GAP volunteer from 1 (Poor) to 5 (Excellent):

    If you wish, please share a story about your volunteer experience:

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