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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:



* Are you a domestic or international student?


* What is the nature of your accommodations? (Please check one)
 Living alone
 Living with roommates
 Married/Common Law
 Living with family (have dependents)
 Other (please specify) 

* 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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