Paley's Pantry Pick-up Request Form
Pantry pick-up is an option for students who are unable to attend any of our in-person pantry dates in a specific month.  After we process your order, we will email you to make arrangements with you to pick up your items on campus - pick up will be in either 125 or 130 of the Library. Please don't hesitate to email us at stuserve@upstate with any questions!
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First Name *
Last Name *
Email address *
Student ID Number *
Please indicate the month you are registering for. *
Have you experienced food insecurity in the past 6 months? *
Are you currently using SNAP (Supplemental Nutrition Assistance Program)   *
Have you used a local food pantry in the Syracuse area in the past 3 months? *
Please share any comments related to you selecting the pick up option rather than the in-person shopping option.
Please check off the FOOD ITEMS requested - some items may not be available.
Please check off the  PERSONAL ITEMS requested - some items may not be available.
Please list any other items or services of which you have immediate need:
Would you like be considered for grocery store or gasoline gift card/ vouchers? (need based) *
Comments/Feedback:
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