Food Pantry Request Form (Full Version)

Student Food Pantry Online Order Form
To better serve and continue to serve, Please complete this order form as you do your shopping.

Bags are provided, although we encourage you to bring your own reusable shopping bags when you can. All students and staff are welcome to take what they need. Please keep shelves and items clean and in its original place.

Please record all items you take from the shelves, even if it is only 1 item. This helps us select what you want to see on our shelves and the people we serve. Note: 1 package = 1 item.
Please submit your order by 5 p.m. on Wednesdays to allow time for your order to be processed.

We will prep your order once your request is received. You may pick up your order at the Lone Tree Campus on Fridays from 9 a.m. to 11 a.m. We cannot guarantee all items on the list will be available at the time you request.

We highly encourage, especially to those who are picking up orders on foot or by bicycle, to bring your own reusable grocery bags to carry your items.

Any orders that have not been picked up on Friday will be returned to the Comet Cupboard. A new request will need to be completed.
Name*

First NameLast Name
CCC Email Address*
AB123@students.coconino.edu
Phone Number*
Please enter a valid phone number.
Please submit your order 72 hours prior to your desired pick-up time to allow for your order to be processed.

Once your order has been received and packed, you will receive an email with information regarding pick up at your desired location. For those arriving on bicycle or on-foot for pick up, we encourage you to bring a reusable grocery bag to carry items when you can.
Preferred Pick-Up Location*

Lone Tree Campus - 2800 S. Lone Tree Road, Flagstaff, AZ 86005Fourth Street Campus - 3000 N. Fourth St.Flagstaff, AZ 86004Page Center - 475 S. Lake Powell Blvd. Page, AZ 86040-0728
What days of the week are you available for pick up at your desired location? Select all that apply.*

MondayTuesdayWednesdayThursdayFriday (Closed in Summers)
I will be arriving at the pick-up location by:*

Vehicle (car, truck, etc)On bicycleWalkingOther
How many people live in your household?*

1-2 people3 or more people
Enter the number of individuals in household.*
Need fresh food? Fresh food boxes are distributed to these locations:
- Fourth Street Campus, 3000 N. Fourth Street, every Friday, 1:30 p.m. - 3:30 p.m.
- Kinsey Inquiry and Discovery School, 1601 S. Lone Tree Rd., every Tuesday, 9 a.m. - 11 a.m.
Type of Pantry Items Needed (Select all that Apply)*

Canned Proteins (tuna/chicken/beans)Canned Vegetables (greens/corn/tomato)Canned FruitsCanned SoupCanned/Bottled BeveragesDry Foods (pasta/beans/rice/ramen/mac-n-cheese)Hot/Cold CerealsChips
Enter Number of Canned Proteins - tuna, chicken, beans*
Enter 0, if no items taken
Enter Number of Canned Vegetables - greens, corn, tomato*
Enter 0, if no items taken
Canned Fruits*
Enter 0, if no items taken
Canned Soups*
Enter 0, if no items taken
Canned/Bottled Beverages*
Enter 0, if no items taken
Dry Foods - pasta, beans, rice, ramen, mac-n-cheese*
Enter 0, if no items taken
Hot/Cold Cereals*
Enter 0, if no items taken
Chips*
Enter 0, if no items taken
Optional: Enter the number of each items you chose above.
We encourage you to bring a reusable grocery bag to carry your items.
What other types of non-perishables would you like to see on the order form?
Should be Empty:

Student Food Pantry Online Order Form