Food Bank Intake Form
Please answer the questions below and provide us enough information to determine whether or not you show financial need and are eligible to use the food bank. Please note that a staff member may contact you if we have follow up questions.
The Sustainability Department has partnered with the MSA to deliver local food market boxes for those students who are eligible. If you select YES, you are consenting to receive an email from the Sustainability department for further information about access the food market boxes.
When you submit this form, MSA Services staff may wish to call or virtually meet with you to confirm this information and financial need. Students with ongoing financial need may be referred to other College services.
DECLARATION: I certify that all the information is correct and true to the best of my knowledge. Any information given in this form will be used to evaluate my need as a student requiring the services of the MSA 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 MSA Food Bank and to conduct myself in an appropriate manner while using the service.