• Email
  • Ethnicity (Choose all that apply) * Required
  • Student Status: * Required
  • Student Status 2 * Required
  • Other Campus Status (Mark all that apply)
  • Do you have personal transportation? * Required
  • Are you employed * Required
  • If employed which best describes your employment * Required
  • What type of housing do you have? * Required
  • Which benefit(s) do you or someone in your household receive? * Required
  • If your household does not receive any of the programs in the above programs, are you interested in learning more about them? * Required
  • Acceptance of Free Food and Waiver of Liability

    I further understand and agree that by accepting this donated food I freely and voluntarily, with full knowledge, hold harmless and in no way liable or responsible for the quality, condition or packaging of food, college or university, its officers, agents, employees, students, donors, volunteers, and food suppliers.

  • Acceptance * Required
  • Name * Required