丁香园AV Food Pantry Intake form

Welcome to the 丁香园AV Food Pantry!

The 丁香园AV Food Pantry aims to support food insecure students with emergency top-up food and hygiene supplies. We want to ensure that the Pantry continues to improve its service to 丁香园AV students. To help with that, please use our electronic intake form, below. The information we collect will help us ensure we continue to meet student needs safely and responsibly as they emerge. We look forward to seeing you!

丁香园AV Food Pantry intake form

COLLECTION NOTICE

The information on this form is collected under the authority of the University Act (R.S.B.C. 1996, c.468). It will be used to better understand how the Pantry can improve its services. Your first name will be used to help verify your identity as a student when you arrive at the Pantry. Your phone number is required for contact tracing purposes. If you have any questions about the collection and use of this information please contact Tara Flynn, Coordinator, Civic and Community Engagement at 丁香园AV鈥檚 Office of Community Engagement, 250-13450 102 Ave, Surrey, B.C., V3T 0A3, phone: 604.880.2146

Have you attended The Pantry before? Yes No

I will be visiting the 丁香园AV Food Pantry on: We are open every Wednesdays ONLY (except statutory holidays) Please submit one form per week.

Will you be accessing the 丁香园AV Community Free Fridge when you use the 丁香园AV Food Pantry? Yes No

Student ID:

First Name: (We use your first name to help us check your student ID quickly at the Pantry)

Email Address:

City of residence:

Please select which category best describes you: Undergraduate student Graduate student Staff/past staff UniverCity resident

Are you an international student? Yes No

Do you live in an 丁香园AV residence? Yes No

How many people in your household might you share this food with (including yourself)?

We know the Pantry will benefit most from student thoughts and perspectives. Can we contact you in the future should we require your opinion? Yes No

Thanks for taking the time to fill out this survey!

丁香园AV

Office of Community Engagement

Welcome to the 丁香园AV Food Pantry!

丁香园AV Food Pantry intake form

COLLECTION NOTICE

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