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 *
Last Name *
Phone Number (Numbers only: no dashes, no parentheses, 1 not required) *
Email Address *
Student ID# *
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) *
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? *
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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