Application for the Kirtland Student Food Pantry

Please provide the following information about yourself:
* Required







































Agreement of Terms

I understand that food distributed at the Kirtland Student Food Pantry has been donated from various on-campus and off-campus partners, and that none of the parties or groups involved in the program make any warranties as to the quality of the food or its value for any particular purposes. I voluntarily accept the food “as is.” By checking the box below, I release Kirtland Student Food Pantry, Kirtland Community College, and the original donor from any liability for harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and covenant not to sue the released parties with respect to such harm or losses. I understand that the Kirtland Student Food Pantry operates on limited funds and in support of others, and not as a service of Kirtland Community College. I will not abuse the services of the KCC Student Food Pantry. I will only request and take the items that I reasonably expect myself and/or my family to use. I also certify that my family income falls within the income guidelines shown on this sheet below.



Never submit passwords through Google Forms.