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ACC - Food Pantry Request Form
Currently enrolled students may request a pre-packaged bag of grocery items up to once a week. Please complete the questions below to better help us serve you. You will receive a confirmation call or email when your requested groceries are ready for pick-up. Please bring your student ID at time of pick-up.
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Email *
Name (First and Last) *
Student ID number *
Birthdate *
MM
/
DD
/
YYYY
Phone Number *
Alamance Community College Active Email Address *
Current Program *
Does anyone in your household have food allergies? *
If yes, please list all food allergies.
How many people are living in your household? *
Are their children in your home? If yes, how many and what are their ages? *
Is there a greater need for a particular meal? *
Special Request List - These items may not always be available, but we will make every effort to meet your need.
Are you in need of toiletry items? *
Required
Would you like to receive any feminine products? *
Required
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