Backpack/Food Box Program                      Enrollment Form 2022-2023                     
Please complete this form and submit to enroll a students weekly food bag program. All answers are confidential and personal information is not shared.
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Email *
1. Student Name (First, Last) *
2. Today's Date *
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3. Does the child receiving the food bag qualify for free/reduced lunch? *
4. Which gender does the child identify as? *
5. Age of the child *
6. Is the child of Hispanic, Latino, or of Spanish origin? *
("a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race")
What is the child's race? (Please check all that apply) *
Required
Is the child receiving the food bag homeless? *
The U.S. Department of Education defines homeless youth as youth who “lack a fixed, regular, and nighttime residence” or an “individual who has a primary nighttime residence that is a) a supervised or publicly operated shelter designed to provide temporary living accommodations; b) an institution that provides a temporary residence for individuals intended to be institutionalized including welfare hotels, congregate shelters, and transitional housing for the mentally ill; or c) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.”
Which best describes the current home situation of the child? *
How many family members are in the home of the child receiving the food bag? *
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