UT Cares Room
Mission Statement: Provide basic needs in order to strengthen students’ confidence and to increase academic achievement and self-image
Please use this form to request UT Cares Room supplies.
* Required
Student name:
*
Your answer
Address:
*
Your answer
Phone number:
*
Your answer
Email address:
Your answer
Gender:
*
Male
Female
Other:
Preferred method to get items:
*
Pick up
Delivery
Other:
Shirt size:
XS
S
M
L
XL
XXL
Other:
Men's jeans/dress pants size (waist on left side, inseam length along top):
28-29
30-31
32-33
34-35
36-37
38-39
28-29
30-31
32-33
34-35
36-37
38-39
40-41
42-43
44-45
46-47
48-49
28-29
30-31
32-33
34-35
36-37
38-39
28-29
30-31
32-33
34-35
36-37
38-39
40-41
42-43
44-45
46-47
48-49
Women's jeans/dress pants/skirt/dress size:
00 / 0
1 / 2
3 / 4
5 / 6
7 / 8
9 / 10
11 / 12
13 / 14
15 / 16
17 / 18
19 / 20
Other:
Casual pants size:
XS
S
M
L
XL
XXL
Other:
Shoe size:
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
13
14
Men's sizes
Women's sizes
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
13
14
Men's sizes
Women's sizes
Type of clothing requested:
Doesn't matter
Brown
Black
White
Gray
Navy blue
Red
Orange
Yellow
Green
Royal blue
Purple
Pink
Dress shirt
Polo shirt
Tee-shirt
Hoodie sweatshirt
Crew neck sweatshirt
Sweater
Jeans
Sweatpants
Leggings
Dress pants
Khaki pants
Suit
Suit coat
Skirt
Formal dress
Jacket
Winter coat
Doesn't matter
Brown
Black
White
Gray
Navy blue
Red
Orange
Yellow
Green
Royal blue
Purple
Pink
Dress shirt
Polo shirt
Tee-shirt
Hoodie sweatshirt
Crew neck sweatshirt
Sweater
Jeans
Sweatpants
Leggings
Dress pants
Khaki pants
Suit
Suit coat
Skirt
Formal dress
Jacket
Winter coat
Type of shoes requested:
Athletic shoes
Dress shoes
Sandals
Work boots
Winter boots
Other:
Accessories requested:
Tie
Belt
Hat
Socks
Gloves
Scarf
Underwear
Bra
Blankets
Sheets
Other:
Toiletries requested:
Toothbrush
Toothpaste
Deodorant
Shampoo
Soap
Shower gel
Comb
Hairbrush
Razor
Shaving cream
Mouthwash
Pads
Tampons
Other:
Other items requested:
Your answer
Anything else the UT Cares room needs to know to better serve you:
Your answer
Please contact Jill Sanders Colgan with any questions: 309.752.1633 jsanderscolgan@uths.net
Submit
Never submit passwords through Google Forms.
This form was created inside of United Township High School.
Report Abuse
Forms
