ASUCC Student Services
The following services are provided by the ASUCC Leadership Board. Please allow up to 72 business hours to be contacted by a member of the team regarding the status of your request. Because we are experiencing a high volume of requests, it can take up to a week for your services to be available for pick up as we may need to restock supplies.  
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Today's Date *
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Academic Year and Term *
Student ID
Name (First and Last) *
Email Address
Phone Number *
Preferred Method of Contact
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Are you an ABS, GED, or ESL Student?
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If you answered No above, please select the number of credits you are enrolled in this term
FOOD BOX PROGRAM
Food Box
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Meat Voucher ($10 for Nickabob's in Roseburg)
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BACKPACK PROGRAM
Please check which services you are requesting
HYGIENE ITEMS
Request limited to twice per term, except for feminine hygiene products
Please check which items you need
LAUNDRY ITEMS
Limit of two vouchers per term
Please check which items you need
TRANSPORTATION
One per term and only one of the items may be selected.
Please check which item you need
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By checking the box, I confirm that I have completed this form with accurate information to the best of my knowledge and understand that intentional misinformation may result in a potential suspension or eligibility for ASUCC Student Services. I also acknowledge that it may take up to 72 business hours to be contacted by a member of the team regarding the status of your request. Because we are experiencing a high volume of requests, it can take up to a week for your services to be available for pick up as we may need to restock supplies.  
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