Welcome to The Food Pantry!

The information provided will only be used by The Food Pantry for funding and research purposes.  It will not disqualify anyone from using The Food Pantry.  All personal information is confidential and is not shared with other organizations or entities.  

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* 1. First and Last Name

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* 2. DVC Student identification number

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* 3. DVC email address

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* 4. Current Address

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* 5. Are you currently employed?

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* 6. How many people live in your household?

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* 7. How many people in your household are under the age of 18?

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* 8. Do you receive CalWORKS benefits?

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* 9. Are you currently enrolled in at least one CE course?

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* 10. Are you currently enrolled in a CE certificate or degree program?

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* 11. Do you currently receive CalFresh benefits?

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* 12. If you do not receive Cal Fresh benefits up to $200 a month, go to the CalFresh application now and apply.

 

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* 13. *Acceptance of free food and waiver liability.

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* 14. I acknowledge receipt of free food from the DVC Food Pantry.

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* 15. Signature:  

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