Food Pantry Request Form

This is a form for students who are in need of food assistance.  Please complete and submit this form to receive a food package.  To be eligible for food assistance for the current month, this form must be completed by Thursday, February 15, 2018.  Food boxes will be available for pick up on February 20, 21 & 22 between 10:00 a.m. – 5:00 p.m. in the Interfaith Chapel.

Your privacy is very important. We are committed to maintaining the confidentiality of those who utilize the Food Pantry.  The personal information you provide is kept strictly confidential.

All participants of the food pantry program must electronic sign the liability waiver form available here (electronic signature available in the form).

After clicking Submit, you will receive an email letting you know that your request has been received.

Food boxes are intended to last one week.  A standard box will include: soup (canned and/or dried), crackers, fruit cups, Mac and cheese or other prepared dinners (with pasta or rice), peanut butter, canned veggies (corn and green beans), canned beans (black, pinto, refried, etc), canned meats (for non-vegetarians), pasta and tomato sauce, and breakfast items like oatmeal, granola bars, protein bars, and pop tarts.  Vegetarian boxes will not include meat, poultry or fish.  In the form below, you can let us know if there are other foods you do not or cannot eat.

Food Request Form

    (Note: If you checked "vegetarian" above, your food box will NOT include meat, poultry or fish)
  • Waiver

    By checking the box below I acknowledge that I have read the liability waiver form. I understand that the waiver form is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read the waiver, and I am signing it freely. No other representations concerning the legal effect of this document.