Swoop's 2018-2019 Intake Form
Please take a moment to answer all questions so that we may serve you better. We are required to obtain the following information from our students for funding and reporting purposes; however, we will serve anyone regardless of ethnicity, race, color, national origin, sexual identity, gender, age, disability, parental status, political, religious, or spiritual beliefs. This information will be kept confidential and will not have a negative effect on services provided to you. Please note the information you provide may be used for grant funding or research purposes but your name and any identifying information will be kept confidential.
E ID (ex. E0123456 *
Your answer
First and Last Name: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
E-mail (ex: swoopspantry@emich.edu): *
Your answer
Current Address (where you live while you're at school): *
Your answer
City/State: *
Your answer
Zip Code: *
Your answer
What is your major? *
Your answer
What is your role at EMU? *
Required
Do you have an EMU meal plan? Please check all that apply. *
Required
If you indicated that you have any meal plan in the previous question, please tell us if you have any issues utilizing your meal plan.
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