Type of Pantry Use Requested?

9 Point (Dorm Student) 16 Point (Off Campus) 25 Point (Off Campus with children)

Terms and Conditions: :

Pantry is used to provide supplemental food and other necessities to MVCC students who are in need.
I will sign in on the C3 computer each time I use the pantry.
I will only use my weekly points and not take additional items, unless approved by staff for extenuating circumstances.
I will not open boxes or enter the back storage area without a staff present.
I will not bring non-students, family members, or friends to use the pantry; we are not a community pantry. We can make referrals to local food pantries for non-students, family members, and friends.
I will not take P-TECH lunches unless they are on the bottom shelf of the refrigerator.
I agree to abide by these terms and conditions, if not, my pantry use privilege will be revoked for the semester.

By my signature, I allow the C3 program to release my information for inter campus communication and referral.

Signature(Please type your name):