Campus Cupboard Visitor Information Form
The information entered will replace the paper form you complete at each visit.

This information is confidential and is used to track data for our records and to better serve the students of WKCTC.

Please use your school email address.
Email address *
Status *
Date *
MM
/
DD
/
YYYY
Last Name: *
Your answer
First Name *
Your answer
Middle Initial *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State Abbreviation *
Zip Code *
Your answer
Cell phone number *
Your answer
Alternative phone number
Your answer
Enrollment Status *
How many credit hours are you currently enrolled in? *
Program of Study at WKCTC *
Your answer
Have you enrolled for summer or fall? *
How many people are in your household including yourself? *
Your answer
What are their relationships to you? Check all that apply. *
Required
Employment *
If employed, how many hours a week do you typically work?
Your answer
Are you the sole provider for your home? *
What needs, besides food, do you have at this time?
Your answer
What other WKCTC campus resources are you using? *
Are you satisfied with the current Campus Cupboard hours? *
Please check all that you have access to when preparing food: *
Required
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