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 Picked Up:
Student Health Center
28000 Marguerite Parkway, SSC 177
Mission Viejo, CA 92692
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
Macaroni & Cheese
PROTEIN (Limit 1)
Corned Beef Hash
FRUIT (Limit 1)
VEGGIES (Limit 1)
DAIRY (Limit 1)
BEANS (Limit 1)
SOUP (Limit 1)
Cream of Mushroom
BREAKFAST (Limit 1)
Oatmeal Packets (x5)
BEVERAGES (Limit 1)
Hot Chocolate (3)
EXTRAS/SNACKS (Limit 1)
Currently enrolled students; please save, fill out form, attach & send to: firstname.lastname@example.org using your student email.