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Cardinal Cupboard Intake Form 2022-2023
To become a Cardinal Cupboard customer, you will need to complete this form once per academic year. Once you have completed this form, you can visit the Cardinal Cupboard and receive food assistance.
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* Indicates required question
Email
*
Your email
I have read and understood the following provisions and agree to be bound by them.
*
Yes
Option 1
Clear selection
Full name
*
Your answer
University ID
*
Your answer
University Affiliation
*
Undergraduate student (freshmen)
Undergraduate student (sophomore)
Undergraduate student (junior)
Undergraduate student (senior)
Graduate student
Metropolitan Student
Chartwells Staff Member
Staff
Faculty
Residence
*
On campus
Off campus
Gender
*
Your answer
What year were you born? (This information will be used to apply for grants that require us to report the age ranges of our visitors. Some grants are for specific age groups, such as seniors or minors.)
Your answer
What is your zip code? If you live on campus only during the school year, please provide your hometown zip code.
*
Your answer
Race/Ethnicity
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White (non-Latin)
Black or African American
Latinx or Hispanic
Mixed race
Native American or Alaskan Native
Asian or Pacific Islander
Middle Eastern
Prefer not to say
Other:
Required
How many people do you plan to feed with food received at Cardinal Cupboard? (Including yourself)
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Your answer
Do you currently have a meal plan through the university?
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Yes
No
How often are you worried about running out of food before you have the means to buy more food?
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Very often
Often
Sometimes
Rarely
Never
How often do you go hungry because you don't have the means to buy more food?
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Very often
Often
Sometimes
Rarely
Never
How often do you skip a meal because you are saving food for later?
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Very often
Often
Sometimes
Rarely
Never
How often can you not eat balanced and healthy meals (including fruits, vegetables, healthy cereals, etc.) because it is too expensive?
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Very often
Often
Sometimes
Rarely
Never
What day of the week is most convenient for you to shop at the Cardinal Cupboard? (Check all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Required
What time of day is most convenient for you to shop at the Cardinal Cupboard? (Check all that apply)
Early Morning (6am - 8am)
Morning (9am - 11am)
Afternoon (12pm - 2pm)
Late Afternoon (3pm - 5pm)
Evening (6pm - 8pm)
Nighttime (8pm - 10pm)
Other:
If the Cupboard were to relocate, which of these sites would you most prefer? (Please number the options 1-4, with 1 being most preferred and 4 being least preferred)
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1
2
3
4
Law School
Curley Hall (near Hartke Theater)
Pryzbla Center
Millennium residence lounge (facing John McCormack St)
1
2
3
4
Law School
Curley Hall (near Hartke Theater)
Pryzbla Center
Millennium residence lounge (facing John McCormack St)
If Cardinal Cupboard offered more services, which would you be interested in?
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Counseling Resources
Healthcare Resources
Housing Resources
English as Second Language (ESL)
Other:
Required
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