Food Request Form
The Birdfeeder will be accessible by request only until further notice. All requests must be made weekly by Mondays or Wednesdays at 11:59 pm. Once a request has been made, you will be able to pickup requested items from Public Safety in the Health Professions Building during normal business hours.

To request food, please follow these steps:
1. Complete the online request form, here: https://forms.gle/ak9b9PJ3n9mVZo3GA
Please note this form is only good for one week. Should you need additional items, please complete a new form.

2. DO NOT arrive at Public Safety until you have received an email stating your items are ready for pickup.

If you have questions, email birdfeeder@daltonstate.edu
Name *
DSC Email *
Phone Number
This will only be used if you do not pickup items by the deadline
Student ID # i.e 900# *
List any allergies or dietary restrictions *
Please mark each of the following that you will HAVE access to during the closure. *
Required
Vegetables (2 Cans)
Please check items you will use. Actual food received will be determined by availability.
Proteins/ Meats (1 Item)
Please check items you will use. Actual food received will be determined by availability.
Beans (1 Can or Bag)
Please check items you will use. Actual food received will be determined by availability.
Clear selection
Condiments/Supplemental Items (1 Item)
Please check items you will use. Actual food received will be determined by availability.
Supplemental Items
Please check items you will use. Actual food received will be determined by availability.
Breakfast Items (1 Large Item or a variety of small items)
Please check items you will use. Actual food received will be determined by availability.
Clear selection
Fruit / Drinks
Please check items you will use. Actual food received will be determined by availability.
Soup
Clear selection
Do you need any personal hygiene items:
Please check items you will use. Actual food received will be determined by availability.
Submit
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