Food Pantry Request Form (Full Version)

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.

The Comet Cupboard is housed at the Lone Tree Campus but is available to serve any CCC student. When you fill out your request, please share which campus you intend to pick-up your request from. All students will recieve a phone call when your order is ready.

Campus Pick-Up Details:

Lone Tree Campus: Please submit your request at any time. The Student Life & Engagement Team will fill your order, to the best of our ability, and have your food available at the Welcome Desk within 1-2 business days.
Fourth Street Campus: Please submit your request at any time. The Student Life Team will fill your order, to the best of our ability, and have your food sent to the Front Desk at the Fourth Street Campus within 2-3 business days.
Page Center: Please submit your request at any time. The Student Life Team will fill your order, to the best of our ability, and have your food sent to the Page Center within 1 week of your request.
Kaibab Campus: Please submit your request at any time. The Student Life Team will fill your order, to the best of our ability, and have your food sent to the Kaibab Campus within 2-3 business days.

Name

First NameLast Name

CCC Email Address

AB123@students.coconino.edu

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

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

What days of the week are you available for pick up at your desired location? Select all that apply.

I will be arriving at the pick-up location by:

Other

How many people live in your household?

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)

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?

Comet Cupboard Online Order Form