Mimi's Pantry Form
Eligibility Application for Mimi's Food Pantry located at the Joseph and Evelyn Lowery Institute For Justice and Human Rights. Please answer all applicable questions.
First Name *
Your answer
Last Name *
Your answer
Phone Number (Numbers only: no dashes, no parentheses, 1 not required) *
Your answer
Email Address *
Your answer
Student ID# *
Your answer
School *
Classification *
Housing *
Are you an Independent Student ? *
Do you have a meal plan? *
What kind of meal plan do you have? (How many meals per Semester) *
Your answer
Have you previously applied to Mimi's Pantry? *
If you Answered "Yes" to the previous question, how many times?
Do you have any known food allergies? *
Your answer
How did you hear about Mimi's Food Pantry ? *
Starting in the Fall of 2017, Mimi's Pantry will provide packages of Fresh Vegetables, Meats, and Toiletries on a 'first-come, first serve' basis, as supplies are available. To apply for one of these additions, please check the corresponding box below. Upon submission, pantry staff will indicate whether supplies are still available.
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