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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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