Food and Basic Needs - Cobb Moms Helping Cobbs

Food/Supplies Request Form

Cobb Moms Helping Cobb request - food/supplies 2026

Are you in need of help? Please complete this application if you live in Cobb County and have children age birth-18 years under your care living with you. There is a separate application on our website for assistance with rent, utilities, etc. This form is ONLY for groceries, toiletries and cleaning supply requests.

We try to help the families of Cobb County with various needs whenever possible. Completion of this application does not guarantee assistance, but we will reach out to you as quickly as possible with more information and/or documentation that might be needed in order to process your request. Please fill out the information below to get started. After we receive your application, we will send an email to the email address used to complete this form, be sure to check your email over the next few days as we work through our applications.

Due to the many requests we receive, if we do not have all the information needed, we will have to move on to the next request. So please make sure to answer all the detailed questions! We don't mean to pry, but we do need some background information in order to make an informed decision. All questions are required to have an answer.

Please keep in mind, our group is run completely by volunteers. We might not be able to get back to you right away, but we promise to do our best to be as prompt as possible! Also, we do not work with a budget, we rely on donations so please understand that we have limited funds to work with. We cannot ever guarantee that we can fill your request, but we will do everything we can to help if we can!!

To learn more about our process, please visit the FAQ's on our website: www.cobbmomshelpingcobb.org/FAQ

If deemed relevant, Cobb Moms Helping Cobb may reach out to local organizations to see if we can gather further details on a situation to help us in making an informed decision. We sometimes rely on other agencies for a more detailed background on a situation. We do not share account information or contact information with third parties without permission.

Help us get to know you and your situation.

The more information you give us here, the faster we can process the application.

Legal Name (First and Last)

Please give us a detailed background of your situation. We cannot help without this information. To speed up your request for help, please give lots of details.

If on FB, please provide the FB profile link (we need the actual link, not the name). ***We might contact you through FB messenger. The URL for our admin profile (Joy Cobb) is https://www.facebook.com/joy.cobb.946. Please send us a friend request so we can see your messages faster.

Address (include lot #, apt # or room # if applicable)

Phone number

How many people live in your household (including adults and children)?

PLEASE ANSWER ALL THE QUESTIONS BELOW. If you have school age children, what schools do they go to? What grade are they in? Have you reached out to the school for assistance?

Can you pick up items or do you need them to be delivered?

Finances

To help us understand your financial situation better, please answer the following questions. We need the cost of each expense that applies to your specific situation. The more information you provide to us in this form, the faster we can process your request! If not applicable, please list N/A.

PLEASE ANSWER ALL THE QUESTIONS BELOW. What is your current monthly income? What is the source of your income? If your income has changed, please provide both the current and past income information.

What is the cost (per month) if you are in a house/apartment?

What is the cost (per month) for your electricity?

What is the cost (per month) for your gas bill?

What is the cost (per month) for your water bill?

What is the cost (per month) for your cell phone bill?

What is the cost (per month) for your car insurance?

What is the cost (per month) for your internet/cable?

What is the cost (per month) for your vehicle?

PLEASE ANSWER ALL THE QUESTIONS BELOW. What is the cost (per month) for transportation if you do NOT own your own vehicle? Is this a car rental, Lyft/Uber or mass transit or combination?

PLEASE ANSWER ALL THE QUESTIONS BELOW. What is the amount you pay (per week) for childcare? Do you receive CAPS daycare assistance?

PLEASE ANSWER ALL THE QUESTIONS BELOW. What is the cost (per month) for medical and prescription costs? Do you receive Medicaid?

What is the cost (per month) for your groceries?

Do you receive SNAP benefits?

If yes, how much do you receive monthly?

If no, why not?

What is the cost (per month) for miscellaneous expenses?

Do you live within the limits of Cobb County, GA?

Do you use illegal substances?

Do you have children birth to 18 years, in your care, living with you?

Do you agree that all information provided to Cobb Moms Helping Cobb Inc is factual?

Do you agree to our privacy policy as stated above and as listed on our website?

Yes

Need Groceries?

Do you need assistance with groceries?

Food assistance needed

Do you receive SNAP benefits?

If yes, how much do you receive monthly?

If no, why not?

What are the ages of the adults and children living with you?

Do you prefer quick and easy meals (ex: chicken nuggets/ mac n cheese/ frozen vegetable) to cook or do you like to cook a full meal (ex: chicken/ potatoes/ fresh vegetables)?

Are there any foods that your family does not eat due to allergies or religious reasons? If so, does everyone in your home avoid eating the particular food?

What time/day are you available to pick up food or have it delivered to you?

If you can pick up, please list the Walmart address for pickup.

Please give us an idea of food/milk that your family prefers. We cannot guarantee all these items but it's helpful to know what your family likes.

If you are in a hotel, do you have access to:

refrigerator

freezer

microwave

oven

stovetop

toaster oven or air fryer

cookware

dishes

Other

Need Cleaning supplies?

Do you need basic cleaning supplies?

Cleaning Supplies

Are there any allergies to cleaning supplies? If so, please specify what the allergy is.

Please give us an idea of cleaning supplies that your family needs. We cannot guarantee all these items but it's helpful to know what your family might be in need of.

Need Toiletries?

Do you need any toiletries?

Toiletries Needed

List the age and gender of each family member in your house.

Are there any allergies to toiletries? If so, please specify who has the allergy and what the allergy is.

Need Baby Diapers/Wipes?

Do you need diapers/wipes?

Diapers

If diapers are needed, please list the age of child, gender and size diapers.