GRCC Student Life Student Food Pantry Intake Form

By completing this form you agree to the Terms and Conditions:
I understand that food can only be picked up by the currently enrolled Grand Rapids Community College student who completed this intake form and that this intake form is only good for one academic term. The student must complete the intake form for each academic term they wish to participate in the program. Only one (1) GRCC student per household may participate in the program. Food can be picked up twice per month using the specific GRCC bag. This bag will be provided on the first visit and must be brought back by the student to receive food on all future visits.

I understand that food I receive from the Grand Rapids Community College Food Pantry has been donated or purchased from several on-campus and off-campus partners and that none of the parties or groups involved in the program make any guarantees as to the quality of the food or its value for any particular purposes. Some of the food distributed at the Grand Rapids Community College Food Pantry has surpassed its “best by” consumption date. The USDA states that “best if used by or before” date is recommended for best flavor or quality. It is not a purchase or safety date.

By signing below, I release Grand Rapids Community College, and the original donor from any liability or harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and covenant not to sue the released parties with respect to such harm or losses.

I understand that the Grand Rapids Community College Food Pantry operates on limited funds and by support of others. I will only request and take items that I reasonably expect myself and/or my family to use. I understand that this is a volunteer program run by donations. We cannot guarantee that we will have food available, but we can suggest additional locations/resources.

Applicant Information
Have you used the GRCC Food Pantry in the past 2 year?
Which semester do you plan to use the GRCC Food Pantry?
Are you part-time (1-11 credits) or full-time (12+ credits) for the semester you chose in the previous question?
What campus to do you attend?
Demographic Questions
What is your age?
What is your Race? Please select one or more.
Are you Hispanic or Latino/a
What is your household income?
Are you a dependent?
How many dependents do you have?
Do you participate in any other food assistance programs (e.g. SNAP/Food Stamps, other food pantry, WIC, etc)?