Food Bank Request Form

DISCLAIMER: All information is for the statistical purposes of the Waterloo Regional Food Bank and the WLUSU Student Food Bank only. Only the WLUSU Student Food Bank and the Waterloo Regional Food Bank will have access to this information.

We have no access to tracking information involving your Student I.D. Your confidentiality is assured.

Due to the needs of the Waterloo community, and to ensure fair access for all students, the Student Food Bank must limit use of the service to 3 requests per student, per term. If you have any questions or concerns regarding this policy, please do not hesitate to contact us at foodbank@wlusu.com. Special circumstances will always be considered.

NOTE: For frozen food requests, please ensure you leave the insulated freezer bag in the locker for future use. All frozen food deliveries will be done by 6pm. If you have not picked up your package by 8pm, it will be removed from the locker to avoid food perishing. Please ensure you are able to go straight home with your frozen food after pick-up.

We appreciate your cooperation! Thank you for using the Student Food Bank!

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Request Form

QUESTIONS

1. Student #:

2. Email address you can be reached at:

(Note: WLU email can be used if you do not wish to reveal your name):

3. Source(s) of income::

4. Do you have any dietary restrictions? (Please be specific: allergies, vegan/vegetarian, kosher, halal, etc.):

5. Do you have any specific requirements? (ie. Do you need baby food? Are there any particular items you do not want?):

6. Would you like FROZEN FOODS included in your package? If yes, check which of the following items you would like. If there is a specific kind of meat you CANNOT have, please indicate in the dietary restrictions section:

	Frozen Vegetables
	Frozen Meat Item
	None

7. Are you in need of any toiletry items? If so, check which ones below (Note: toiletries are occassional items. We may not have them upon request):

	Soap
	Shampoo
	Conditioner
	Toothpaste
	None

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