Food and Toiletries Request
Hello! Please fill out this form to request food and toiletries from Secure the Student. Once received, we will be in touch within 48 hours for delivery. To ensure that we are providing you with items that you enjoy/need, please select the items you'd like from the list below. We look forward to assisting you!
*For delivery, individuals must be enrolled undergraduate students at a community college or 4-year institution in the greater Richmond, Virginia area. For other Virginia students, please email
so that we may further assist you.*
Beef ramen noodles
Beef and vegetable soup
Chicken ramen noodles
Chicken noodle soup
Mac & Cheese
Oatmeal – Maple & brown sugar
Pasta sauce – Traditional/Tomato basil garlic
Pasta sauce – Meat flavored
Peanut butter crackers
*Fresh fruits and vegetables available upon request
Date of birth
College email address (please refrain from using personal email address)
Address for delivery
Grade point average
Are you unhoused or in transitional housing?
Please check beside your source(s) of income
Social security disability (SSDI)
Social security (SSA)/Supplemental security income (SSI)
Please check beside other programs you participate in
Temporary Assistance for Needy Families (TANF)
Women, Infants, and Children (WIC)
Food stamps (SNAP)
No other programs
How did you hear about Secure the Student?
Food/toiletry items needed
I understand that Secure the Student has the right to deny, partially, or fully grant my request.
For delivery, I understand that I must be an enrolled, undergraduate student at a community college or 4-year institution in the Greater Richmond, Virginia area.
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This form was created inside of LaQuayle Agurs.