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Alva Campus Food Request Form

(For best results, please fill out this form using the Google Chrome Browser.)

We respectfully ask that this form be submitted to us by 5 p.m. on Mondays and no later than 3 p.m. on Wednesday to better serve you. The Monday deadline is mandatory if requesting milk and/or eggs (when available).

Personal information will be kept confidential. Students and employees utilizing the Campus Cabinet Food Pantry must show a valid Northwestern ID at the pantry. IDs are available via Student Services, first floor Ryerson Hall.

A Campus Cabinet ID Number and Card will be issued to you upon your first visit. You will continue to use this card during your time at Northwestern. Please provide your number on the form below each time you fill it out after your first visit.

You may visit the Campus Cabinet one time per week.

Required

In order to assist, we must require that ALL food requests be made via our online web form only until further notice.

Distribution will be Wednesdays by appointment from 5-6:50 p.m. when school is in session. If you cannot schedule a Wednesday appointment, you will need to contact Angelia Case for an alternate day and time. If you are unable to make your appointment time, please let us know so that you can schedule an alternate time.




You will use your name and email address on this form, as well as your Campus Cabinet ID#. Your information will not be shown publicly.



__________________________________________________________________________________________________
For Campus Cabinet Use:

Date Received: _______________Dated Filled: _________________ Date Picked Up: ________________

CC ID#: ______________________ Pounds Received: ____________ Filled by: ________________________

Personal Information

I live *
I have access to (check all that apply) *
Sugar-free Products Needed (if available)? *

Milk Request -- Form must be completed by 5 p.m. Monday to be considered for milk. Alva campus only.

*

FOOD SELECTION: Everything below may not be available. It’s a guide. It is YOUR responsibility to leave behind any foods/items you cannot use due to dietary restrictions or allergies or anything you do not want to use. A box is provided for you to leave those items behind.

MISCELLANEOUS FOODS, SNACKS, OTHER - Items will continue to vary
SOUPS *
CANNED MEAT *
GRAVY (when available) *
CANNED VEGETABLES
CANNED FRUITS *
INSTANT POTATOES *
RAMEN NOODLES *
BEANS *
CANNED PASTAS (as available) *
PACKAGED RICE (as available) *
PACKAGED PASTA (as available) *
MICROWAVE MEALS (as available) *
PASTA SAUCES *
CONDIMENTS *
BREAKFAST *
SNACKS - when available *
DRINKS *
PEANUT BUTTER & JELLY *
HYGIENE ITEMS - FEMALE *
HYGIENE ITEMS - MALE *
OTHER HYGIENE ITEMS *
FEMININE PRODUCTS *
PAPER PRODUCTS *
BEDDING/ other -if available *
Limited Number of Misc Warm Clothing Items (can check sizes during appointment) *
School Supplies (when available) *

Deterra Drug Deactivation Pouches - will safely neutralize pills, liquids and patches

Statement of Understanding: I will make an appointment to pick up my order by going to . I understand that if I have not made an appointment by 5 p.m. Friday of the week it was submitted, the food order will be disassembled and a new food order will need to be submitted for the next week. There is only one food disbursement each week. I understand that a previous week's order may not be picked up on a Monday, etc.

By checking the box below, it will serve as my electronic signature. I acknowledge that I will be receiving free food from the Campus Cabinet. I understand this is a gift and not a reoccurring obligation by the university, Campus Cabinet or fiscal sponsor. I further understand and agree that by accepting this donated food, I freely and voluntarily, with full knowledge, hold harmless and in no way liable or responsible for the quality, ingredients used in, condition or packaging of food, Northwestern, its officers, agents, employees, students, donors, volunteers and food suppliers. I also acknowledge that I may visit the Campus Cabinet one time per week.

 Acceptance of Free Food and Waiver of Liability

PLEASE NOTE: We want to be able to serve as many students and employees as possible. Therefore, we ask that you refrain from requesting items that you have left over from your prior visits or keep items in your bag that you know you cannot or will not use. We will provide a box outside the Pantry door and respectfully ask that you leave behind any items that come in your bag that you know you will not use. Thank you!

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709 Oklahoma Blvd., Alva, OK 73717
Phone: (580) 327-1700

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University. All Rights Reserved.

Mission Statement

·¬ÇÑÊÓƵ provides quality educational and cultural opportunities to learners with diverse needs by cultivating ethical leadership and service, critical thinking and fiscal responsibility.