Fillable Student Health Center Food Pantry Request Form (Saddleback College)

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Student Health Center Food Pantry Request Form (Saddleback College)

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PLEASE NOTE: ORDERS MUST BE RECIEVED BY TUESDAY BY 10AM, PRIOR TO WEDNESDAY'S DISTRIBUTION.
When placed after 10am; the order will be filled the following week. The food pantry is distributed by appointment only, you must enter
campus at College Drive/across from Mission Hospital on Marguerite Parkway. Campus Police will be at the bottom of the hill and request;
Your Student Number, Name and the Reason you are on campus. Proceed to the round-about, staff will be at the bus stop by the flag pole.
Please practice safe social distancing protocols; wear a mask, roll down your passenger side window or pop open your trunk; we will place
your bag inside your vehicle. Please remain in your car and drive off campus. At this time no one is allowed on campus without permission.
We are serving as many students & staff as possible, please refrain from requesting duplicate items left over from previous visits.
We do our best to keep our items stocked if a choice becomes unavailable it may be replaced with another item. Thank you!
FOR OFFICE USE ONLY: Date Received:
Date Filled:
Date Picked Up:
Student Health Center
Saddleback College
28000 Marguerite Parkway, SSC 177
Mission Viejo, CA 92692
Phone: 949.582.4606
Food Pantry Request Form
First & Last Name: _______ Student/Staff ID # _______
Date of Pick Up (WED): Time: TBD by SHC Weekly Phone Number: _______
Total Household Size: Number of Adults: Number of Children (0-18): _________
I have access to: Stovetop Oven Microwave Can Opener Running Water
Dietary Restrictions:
Notes: _______________________________________________________________________
PASTA/GRAINS/BREADS (Limit1)
Rice
Pasta
Macaroni & Cheese
Crackers
PROTEIN (Limit 1)
Peanut Butter
Beef
Tuna
Spam
Chicken
Corned Beef Hash
Vegan Patty
FRUIT (Limit 1)
Fresh Seasonal
Fruit Cups
Apple Sauce
VEGGIES (Limit 1)
Canned
Sauce
DAIRY (Limit 1)
Cheese
Milk
Yogurt
BEANS (Limit 1)
Black
Cannellini
Kidney
Refried
Garbanzo/Chick Peas
SOUP (Limit 1)
Chicken Noodle
Tomato
Cream of Mushroom
Vegetable
BREAKFAST (Limit 1)
Cereal (Individual)
Oatmeal Packets (x5)
Granola/Oat Bars
Nutri-Grain Bars
BEVERAGES (Limit 1)
Coffee (3)
Tea (5)
Hot Chocolate (3)
EXTRAS/SNACKS (Limit 1)
Jell-O
Nutella
P.B./Cheese Crackers
Pudding
Nuts
DRESSINGS/CONDIMENTS
Dressing
Mustard
Mayonnaise
Jelly
Maple Syrup
CLEAR
Allergies:
Currently enrolled students; please save, fill out form, attach & send to: scstudenthealth@saddleback.edu using your student email.
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Student Health Center Food Pantry Request Form (Saddleback College)

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Completed 2 February 2021

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