CALFRESH APPLICATION ASSISTANCE REQUEST
Students can get extra help for monthly expenses. You may not have to choose between textbooks or food anymore! You may be eligible for CalFresh Benefits. This entry will be shared with our community partners in an effort to provide you with all resources available to you. 

**You may select to receive a copy of your responses for your records.
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Email *
MJC Student Email *
W Number 
Please enter your MJC Student Identification Number (without the "w")
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Last Name(s), First Name *
Please enter your last name then your first name as it appears on MJC records
Phone Number
Please enter the best phone number to reach you on
 *
Day(s) 
Select all of the days that you are available for a pre-screen appointment 
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Required
Time(s)
Select all of the time frames that you are available for a pre-screen appointment
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Required
Select all that apply
Please indicate all classifications you identify with
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Required
CalFresh History 
Have you participated in the CalFresh program before? Or are you currently in the program? 
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May we share information entered above with our community partners? *
IF YOU DO NOT CONSENT, PLEASE DO NOT SUBMIT THIS FORM AND CONTACT OUR BASIC NEEDS PROGRAM STAFF FOR FURTHER INSTRUCTIONS.
Pirates' Pantry is committed to provide you with excellent service. Please tell us how we are doing by sharing your experience and/or any comments below. You may also visit our webpage for more information. 

Your participation and feedback in all Basic Needs services help us continue to provide excellent service. 
#MJCPiratesPantry #HungerFreeMJC #MJCSTRONG
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A copy of your responses will be emailed to the address you provided.
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