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Food Pantry Pick-Up Request

Home » On-Campus Food Pantry » Food Pantry Pick-Up Request

"*" indicates required fields

Name*

First Last

Student Email*

Food pantry pick-ups are for students only. Please enter your VCCS student email address.

Enter Email Confirm Email

College Location*

Middletown Campus

Fauquier Campus

Pick-Up Date*

Please select a pick-up date. NOTE: Your date will be confirmed by a college staff member after submitting this request.

MM slash DD slash YYYY

Pick-Up Time*

Please select a pick-up time. NOTE: Your time will be confirmed by a college staff member after submitting this request.

Hours

:

Minutes

AM/PM

Pick-Up Method: Middletown Campus*

Pick up your items in-person in room 607 Cornerstone Hall (Student Support office)

Have items brought out to your car (park behind Student Support Office by steps)

Pick-Up Method: Fauquier Campus*

Pick up your items in-person in Room 217 Wolk Hall (Financial Aid)

Number of people living in your household:*

Click the “+” sign to add another household member. Example: Self, 42. Spouse, 40

Relationship

Age

Food allergies (if any):

Preferred items (subject to availability):*

Please check all that apply.

Canned vegetables

Dry beans

Elbow macaroni noodles

Spaghetti noodles

Macaroni & cheese box dinner

Tomato sauce (for pasta)

Diced tomatoes

Canned Soup

Beef Stew

Pork and beans

Top Ramen

Rice

Canned meat (tuna and/or chicken)

Cereal

Oatmeal

Pancake mix

Peanut butter

Grape jelly

Strawberry jelly

Canned fruit

Applesauce

Breakfast bars

Bar soap/body wash

Toothbrush

Toothpaste (mini)

Shampoo/Conditioner

Deodorant

Razor

Feminine hygiene supplies (pads and/tampons)

Pet Supplies

Other

Other items requested:

Please enter your VCCS student email address to allow submission of this form.

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