Student Enrollment Form - Celiac Disease Food Insecurity Resource Network

The Celiac Disease Food Insecurity Resource Network (CD-FIRN) helps students with celiac disease who may be facing food insecurity access safe, gluten-free foods. This program is offered by the Celiac Disease Foundation in partnership with the Food Equality Initiative. Thanks to the generosity of an anonymous donor, we are able to provide a limited number of gluten-free food boxes to students. Because supplies are limited, enrollment will be accepted on a first come, first served basis.

Agreement and Consent:

We want this program to be fair, safe, and supportive for all participants. By enrolling, you acknowledge and agree to the following:

Eligibility

I confirm that I am currently enrolled at either UC Davis or Cal Poly San Luis Obispo.
I have been medically diagnosed with celiac disease and could benefit from food support at this time.
I understand that I may be asked to provide confirmation of my celiac diagnosis (for example, a doctor’s note) if needed to verify eligibility.

Program Purpose

I understand that this program is designed to support students experiencing food insecurity by providing a box of gluten-free foods.

Distribution Guidelines

To ensure that as many students as possible can participate, each household may receive only one food box.

Privacy and Respect for Your Information

I consent to share my name, contact information, and shipping address with the Celiac Disease Foundation and the Food Equality Initiative so they can:
- Enroll me in the program
- Deliver my gluten-free food box
- Communicate with me about my enrollment or shipment
My information will only be used for these purposes and will not be shared or sold.
I may request to have my information deleted at any time.

Program Communications

I agree to receive occasional email, text, or phone updates from the Celiac Disease Foundation and the Food Equality Initiative related to my participation in this program.

Food Safety

I understand that all products are sourced and packaged by the Food Equality Initiative.
I will check the ingredient labels of all food items to ensure they meet my personal dietary needs.

Acknowledgment

I understand that participation in this program is voluntary.
The Celiac Disease Foundation and Food Equality Initiative are not responsible for any reactions or effects related to the products received.
The Celiac Disease Foundation makes no representations or warranties, either express or implied, that any products or services delivered via this program adhere to or satisfy any standards or requirements that may be applicable to such product or service and that no warranty, express or implied, is created by providing information and does not in any way constitute an endorsement by the Celiac Disease Foundation. You agree that in no event shall the Celiac Disease Foundation be held liable to you or anyone else for any products or services delivered to you during this Program.

Celiac Disease Foundation Privacy Policy
Food Equity Initiative Privacy Policy

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* 1. By submitting this form, I confirm that I have read, understand, and agree to all of the above information.

Yes, I agree, understand, and consent to all of the above.

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* 2. Please tell us which school you attend to verify eligibility:

Cal Poly San Luis Obispo

UC Davis

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* 3. Please provide your official student email address (.edu) to confirm eligibility:
(Your student email will be used only to verify eligibility and communicate about your participation in this program. It will not be shared or sold.)

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* 4. Please provide your Student ID Number to confirm eligibility:
(Your student ID will be used solely to verify your enrollment status with your university. It will not be shared with any other organization and will be deleted after verification or shipment confirmation.)

Student Enrollment Form - Celiac Disease Food Insecurity Resource Network

Question Title

* 1. By submitting this form, I confirm that I have read, understand, and agree to all of the above information.

Question Title

* 2. Please tell us which school you attend to verify eligibility:

Question Title

* 3. Please provide your official student email address (.edu) to confirm eligibility:(Your student email will be used only to verify eligibility and communicate about your participation in this program. It will not be shared or sold.)

Question Title

* 4. Please provide your Student ID Number to confirm eligibility:(Your student ID will be used solely to verify your enrollment status with your university. It will not be shared with any other organization and will be deleted after verification or shipment confirmation.)

* 3. Please provide your official student email address (.edu) to confirm eligibility:
(Your student email will be used only to verify eligibility and communicate about your participation in this program. It will not be shared or sold.)

* 4. Please provide your Student ID Number to confirm eligibility:
(Your student ID will be used solely to verify your enrollment status with your university. It will not be shared with any other organization and will be deleted after verification or shipment confirmation.)