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Backpack/Food Box Program Enrollment Form 2020-2021-
Please complete this form and submit to enroll a students weekly food box program
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* Indicates required question
Email
*
Your email
1. Student Name (First, Last)
*
Your answer
2. Today's Date
*
MM
/
DD
/
YYYY
3. Does the child receiving the food bag qualify for free/reduced lunch?
*
Yes
No
4. Which gender does the child identify as?
*
Male
Female
Prefer not to say
Non-Binary
5. Age of the child
*
Your answer
6. Is the child of Hispanic, Latino, or of Spanish origin?
*
Yes
No
What is the child's race? (Please check all that apply)
*
American Indian or Alaskan Native
Asian
Black/African American
Hawaiian or Pacific Islander
White
Other Single Race
Required
How many family members are in the home of the child receiving the food bag?
*
1
2
3
4
5
6
7
8 or more
Which best describes the current home situation of the child?
*
Single Female Parent
Single Male Parent
Two parents
Unaccompanied youth
Other (living with grandparents or other family, friends, etc.)
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