Online Food Pantry Request Form

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The FVCC Food Pantry provides a free service to students currently enrolled in classes, who are in need of emergency food assistance. This form will be used to track data for college reporting purposes only. All information will be kept confidential.

Student ID Number *

Email *

Is this your first time visit? *

Yes

Required

Status in school *

Full-time (12 credits or more)

Part-time (under 12 credits)

Required

Are you a veteran?

Yes

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What type of housing do you have? *

On-campus

Off-campus

Other:

Are you currently employed? *

Yes

Required

Including yourself, how many individuals are in your household?(household = you + dependents) *

Are there individuals are under the age of 18? *

How many in your household are enrolled at FVCC? (household= you+dependents) *

Would you like to: *

visit the Food Pantry in-person;or

receive your groceries curbside?

What day and time works best for you to receive groceries? *

You acknowledge that receipt of free food from the Flathead Valley Community College Food Pantry is a gift and understand that, as a gift, it is not a reoccurring obligation of FVCC. By participating in the FVCC Food Pantry, you release FVCC, its employees, agents and volunteers, and the original donor, from any liability for harm or losses in connection with the food received. Further, you agree that you assume any risks associated with the acceptance of such food, and covenant not to sue the released parties with respect to such harm or losses. You understand that the FVCC Food Pantry operates on limited funds from private donations and FVCC Student Government, and thus any choices available may change and the Food Pantry may be discontinued at any time if the sources of funding are not renewed. You will not abuse the services of the FVCC Food Pantry and will only request and take the items that you reasonably expect you and/or your family to use. Lastly, you understand that the privilege of using the pantry may be denied at any time for violation of the FVCC Code of Student Conduct. *

I have read and understand the disclaimer above, agree to abide by the FVCC Food Pantry guidelines, and have provided information that is truthful and accurate to the best of my knowledge.

Required

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