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Feed U Pantry Sign-up

NOTE: The following information will be used only by Feed U Food Pantry management for agency reports and metrics. Your identity will remain confidential.

Information
*Indicates a required field.
  1. Primary Household Ethnicity
  2. Household Type
  3. Housing Status
  4. Campus Location
  5. How long do you expect to need food assistance
  6. Current Sources of Income(Check all that apply.)
  7. Does anyone in the household need help with any additional resources(Check all that apply.)
  8. Reason for Need of Food Assistance(Check all that apply.)
  9. How did you hear about the FEED U Pantry
  10. Please read and sign the following:

    I understand that the food from University of Utah Feed U Pantry may only be distributed to a current University of Utah student for themselves and their dependents (spouse and children under the age of 19). I also understand that the University of Utah Feed U Pantry has been donated from various on-campus and off-campus partners, and that none of the parties or groups involved in the program make any warranties as to the quality of the food or its value for any particular purposes. Some of the food distributed at the University of Utah Feed U Pantry has surpassed its "Best by" consumption date. This date is for peak flavor and quality, and is not a purchase by or safety date. I and my family release the University of Utah and its off-campus partners from any and all responsibility concerning the quality and safety of the University of Utah FEED U Pantry.

Head of Household Information
  1. Gender
  2. Marital Status
  3. Hispanic / Latino - Non-Hispanic
  4. Primary Ethnicity
  5. Student Status
  6. Current College Level
  7. Currently Employed?
  8. Started a Job (last 30 days)
  9. Income Increased(last 30 days)
  10. Currently receiving the following benefits(Check all that apply.)
  11. Please check all that apply
2nd Member of Household
  1. Gender
  2. Marital Status
  3. Hispanic / Latino - Non-Hispanic
  4. Primary Ethnicity
  5. Student Status
  6. Current College Level
  7. Currently Employed?
  8. Started a Job (last 30 days)
  9. Income Increased(last 30 days)
  10. Currently receiving the following benefits(Check all that apply.)
  11. Please check all that apply
3rd Member of Household
  1. Gender
  2. Marital Status
  3. Hispanic / Latino - Non-Hispanic
  4. Primary Ethnicity
  5. Student Status
  6. Current College Level
  7. Currently Employed?
  8. Started a Job(last 30 days)
  9. Income Increased(last 30 days)
  10. Currently receiving the following benefits(Check all that apply.)
  11. Please check all that apply
4th Member of Household
  1. Gender
  2. Marital Status
  3. Hispanic / Latino - Non-Hispanic
  4. Primary Ethnicity
  5. Student Status
  6. Current College Level
  7. Currently Employed?
  8. Started a Job(last 30 days)
  9. Income Increased(last 30 days)
  10. Currently receiving the following benefits(Check all that apply.)
  11. Please check all that apply
Last Updated: 8/7/17