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The Sharing Shop


About The Sharing Shop Intake Form Collective Kitchen Resources Toolbox The Sharing Shop Intake form
* indicates a required field.

* First Name:


* Last Name:


* Student Number:


* Email Address:


* Program Name:


* Level:


* Campus Location:


* Date of Birth:
  


Home address


* Street:


* City:


* Province:


* Postal Code:



* What is the nature of your accommodations? (Please check one)
 Living in Residence
 Domestic Students (living alone)
 Domestic Student (with roommates)
 Family (with dependents)
 International Student (living alone)
 International Student (with roommates)
 Married
 Single
 Common Law
 Other

* Number of family members accessing groceries (this includes only spouse, dependants and yourself):


* Number of times you grocery shop per month:


List any allergies or food restrictions (if any) you have:


Additional Comments:


DECLARATION: I certify that all the information is true to the best of my knowledge. Any information given in on this form will be used to evaluate my need as a student requiring the service of The Sharing Shop (FSU - Emergency Food Bank) and will only be used for this purpose. All information will remain confidential and will not be shared with any other party. I agree to follow the rules of The Sharing Shop and to conduct myself in an appropriate manner while using the service.

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