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Food Pantry Application
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Name
*
Your answer
Phone Number
*
Your answer
Outside email address (other than WSCC, if applicable)
*
Your answer
Student ID
*
Your answer
Do you have any dietary restrictions or are there any food allergies in your household?
*
Your answer
How many children (0-18 yrs.) are in your household and what are their ages?
*
Your answer
How many adults are in your household?
*
Your answer
Is anyone else in your household currently receiving assistance from the WSCC food pantry?
*
Yes
No
Are you eligible to receive the Pell Grant?
*
Yes
No
Don't Know
What do you have available at home? (select all that apply)
*
Stove Top
Oven
Microwave
Can Opener
Running water
Refrigerator
Required
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