* Required

Living Well Community Resource Center Intake Form - Summer 2021

Please submit this form if this your first visit of the spring.

*Only available for US Citizens and Permanent Residents* *Students with 11 meal plans or more do not qualify*​
You may receive up to $194 a month for groceries (previously known as food stamps), please mark the eligibility criteria that are applicable to you below. Students (ages 18-49) must be enrolled at least half time, meet income limit, and meet at least ONE of the following exemptions. ​​​***Students under the age of 22 living with their parents must apply with their parents as a household***​​​
Check all that apply.​​​​​​​​​​​​ If you are eligible, we will contact you to set up an appointment to help you complete an application.
"I accept the food and personal hygiene items 'as is' and at my own will. I understand that many of the items available come close to 'best-by' and 'expiration dates' but that the items have been inspected for safety and quality. I understand the Good Samaritan Food Donation Act: The law protects good faith food donors from civil and criminal liability, should the item later cause harm to its recipient." ​​​​​​
"I acknowledge that I will follow the bag limit system. I acknowledge that the only intended purpose of receiving items is to feed myself and/or my dependents. Actions that violate the intended purpose of the Living Well Community Resource Center include but are not limited to: sale or exchange of food items for monetary gain."​​​​
"I acknowledge that the food from the Living Well Community Resource Center is intended for Vanguard Community members who have limited resources or financial challenges."​​​

Please provide an email address where we can send a link to your current form.

Email Address :