Food Pantry After-hours pick-up Lockers

1

Name* This field is required.

First Name

Last Name

2

Sac State Student ID Number* This field is required.Please double check accuracy! This is how we will get you registered to use the Pantry Lockers.

3

CSUS Email* This field is required.CSUS email required

example@example.com

4

Phone NumberOptional

Please enter a valid phone number.

5

Appointment* This field is required.Select the day you would like to pick-up items.

6

Please list any dietary restrictions we should now about when preparing your items.

7

Blue Section: Toiletries & Cleaning supplies* This field is required.Limit: 2 items (no duplicates permitted on Laundry Detergent & Toilet Paper)

Toothbrush

Floss

Body Wash

Shampoo

Surprise me

None

11

Do you need any menstrual products?You can select both. No limit

Pads

Tampons

Both

None

13