First Time Campus Cabinet User Application

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First Time Campus Cabinet User Application - Alva Campus
Personal Information
Name

First NameLast Name
NWOSU Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Hometown Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age
Gender
Major/Minor or Employee if not student
Classification
Ethnicity (check all that apply)
If Other, explain:
Campus Status (choose all that apply)
First-generation student (neither parent or grandparent attended college)
Household Information
What type of housing do you have?
If Other, be specific
Cafeteria Meal Plan
At NWOSU, how many family members are you provided food for?
Do not include fellow NWOSU roommates - they can visit the Pantry themselves.
How many are under age 18?
Do you have a vehicle/access to transportation?
Do you receive/use financial aid/scholarships? (choose all that apply)
If Other, be specific
Employment Info
How many family members at your NWOSU residence are employed
Do not county NWOSU roommates
Government assistance benefits you or someone in your NWOSU residence receive? (choose all that apply)
If Other, please specify
Do you identify with any of the following? (choose all that apply)
If Other, please specify
Has a lack of funds for food caused you to do any of the following within the last year? *
If Other, please specify
How did you hear about the Campus Cabinet Food Pantry?
List needs, other than food, that you would like info on (counseling, food stamps, shelter, other forms of assistance, etc.) so we can try to help provide contact information for these areas.
Other Needs:
Comments/Questions:
Terms & Conditions:

I acknowledge that I will be receiving free food from the Campus Cabinet. I understand this is a gift and not a recurring obligation by the university, Campus Cabinet or fiscal sponsor. 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, ingredients used in, condition or packaging of food, Northwestern, its officers, agents, employees, students, donors, volunteers and food suppliers. I also acknowledge that I may visit the Campus Cabinet one time per week.
Acceptance of Free Food and Waiver of Liability
Signature of Understanding
Please verify that you are human
Should be Empty:

First Time Campus Cabinet User Application - Alva Campus

Personal Information

Household Information

List needs, other than food, that you would like info on (counseling, food stamps, shelter, other forms of assistance, etc.) so we can try to help provide contact information for these areas.