Lynn Locker Order Form

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⚠️⚠️We apologize for the limited inventory. The Lynn Campus Cupboard will be fully restocked on 9/11. Please plan to place your locker order then!!⚠️⚠️

Please fill out the information below as accurately as possible. To ensure fair access to all students, we kindly ask that you limit your locker orders to one per week.

Please allow 24–48 hours for delivery. Orders placed after 2:00 PM on Thursday will be fulfilled the following Monday.

Email *

Record my email address with my response

This information will be confidential and only viewed by Wellness staff. Only your name, household size and zip code will be shared with our partner "The Open Door" who supplies all of our food, for their data/reporting purposes.

I Understand

Required

Last Name *

First Name *

Phone Number *

NSCC Email *

Student ID #

Zip Code *

Do you need a locker within the disability accessibility height range?
*

Yes

Below are the food options currently available. Please only select the items you would like to receive.

Milk (shelf-stable) *

Rice *

Mixed Fruit (canned) *

Peas (canned) *

Carrots (canned) *

Chicken Noodle Soup (canned) *

Pad Products (donated by Dignity Matters) *

Box of Tampons (donated by Dignity Matters) *

Body Wash *

Is this your first time placing Campus Cupboard Express Locker order?

If Yes, please answer the following question before submitting your order.

If No, skip the following 5 questions and start your order.

Yes - answer the next 5 questions

No - skip the next 5 questions

How many people live in your household (including yourself) ?

Do you support children or other legal dependents?

Have you ever used a food pantry?

Yes

Clear selection

Please Select any of the following that apply to you...(This will NOT be shared with anyone and is voluntary. If you choose to answer this question, a staff member from the wellness team will contact you to follow up with additional resources)

I am homeless or at risk of being homeless

I feel unsafe at home

I am more than 2 months behind on any of my utility bills

I would like resources to support my mental health

Do you currently utilize any other kind of food assistance? (Please select all that apply)

SNAP (Food stamps/EBT)

WIC

Submit

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