Backpack/Food Box Program Enrollment Form 2021-2022

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Please complete this form and submit to enroll a students weekly food box program

Email *

1. Student Name (First, Last) *

phone number

2. Today's Date *

YYYY

3. Does the child receiving the food bag qualify for free/reduced lunch? *

Yes

4. Which gender does the child identify as? *

Male

Female

Prefer not to say

Non-Binary

5. Age of the child *

6. Is the child of Hispanic, Latino, or of Spanish origin? *

Yes

What is the child's race? (Please check all that apply) *

American Indian or Alaskan Native

Asian

Black/African American

Hawaiian or Pacific Islander

White

Other Single Race

Required

How many family members are in the home of the child receiving the food bag? *

8 or more

Which best describes the current home situation of the child? *

Single Female Parent

Single Male Parent

Two parents

Unaccompanied youth

Other (living with grandparents or other family, friends, etc.)

Does this student/family need a "hotel" bag? A hotel bag is for students and families who do not have access to a traditional kitchen, and only includes foods that require a microwave and/or hot water, as well as foods that do not require any prep.

yes

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This form was created inside of Vancouver School District.