Student Nutrition Assistance Kit Intake Form

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Student Nutrition Program Intake Form

Welcome to the Student Nutrition Program’s Food Pantry. We’re here to help in times of emergency.

Important Information:

• You will be asked for information about yourself, your student status at SLC, your job, income, expenses, and other resources you’ve used. We use this information to provide better service to you and all students.

• Your answers are confidential unless explicitly stated and agreed to by you

• We’ll review your application upon receipt and may contact you for more details if needed. Please allow up to 3 business days for processing.

• To learn more about the Student Nutrition Program or other services by the Student Association, visit www.saslc.ca.

• If you have questions, contact us at sabusman@sl.on.ca.

To learn more about the Student Nutrition Program or other services by the Student Association, visit www.saslc.ca.

If you have questions, contact us at agoodwins@sl.on.ca.
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The Student Nutrition Program's Food Pantry provides access to nutritious food and resources for current St. Lawrence College Kingston students. The Student Nutrition Program's Food Pantry is intended for those experiencing food insecurity or at risk of experiencing food insecurity in the immediate future and need a 2 - 3 day supply of food.* This field is required.If you understand and agree with the purpose of the Student Nutrition Program's Food Pantry, please indicate below:
I understand and agree with the purpose of the SNAK
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Name* This field is required.
First Name
Last Name
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Student Status* This field is required.
Please enter your student email
Please enter student number
What semester are you in?
Program of study
Please Select
Please Select
Male
Female
Trans* Identified
I prefer not to say
Other
Gender
Please Select
Please Select
Single/Divorced/Separated
Married/Common-Law
Widowed
I prefer not to say
Other
Matital Status
Please Select
Please Select
Domestic student
International student
How do you identify as a student?
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Have you previously participated in the Student Nutrition Program or accessed the Food Pantry on campus?* This field is required.
Yes
No
Prefer not to answer
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When did you last access the SNAK (Student Nutrition Assistance Kit) service?
Please Select
Please Select
This month (within 30 days)
This Semester (within 90 days)
This year
Never
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Which of the below have you used in the past month?* This field is required.
Bread of Life Club
Martha's Table
Seventh Day Adventist Church
St. Andrew's Church
St. George's Cathedral
St. Mary's Cathedral
St. Paul's Anglican Church
St. Vincent de Paul
None of the Above
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Which of the below Food Bank Programs have you accessed, or attempted to access, in the past month?* This field is required.
Central Frontenac
North Frontenac Food Bank
Partners in Mission
Salvation Army North
St. Vincent de Paul
None of the Above
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When was the last time you accessed the resources on the previous question?
Please Select
Please Select
Within the last month
Within the last 6 months
Within the last year
Never
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Do you have any dependents?* This field is required.
Please Select
Please Select
Yes
No
Do you have dependents?
How many dependents in your household reply on you for food?
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Food insecurity details:* This field is required.
Please Select
Please Select
Daily
Weekly
Occasionally
Never
How often do you, or one of your dependents, skip meals?
Please Select
Please Select
Daily
Weekly
Occasionally
Never
How often do you, or one of your dependents, reduce portion sizes to save food?
Please Select
Please Select
Daily
Weekly
Occasionally
Never
How often do you run out of food?
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Are you currently employed?
Yes
No
I prefer not to say
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How many hours per week do you work?
15
What is your total approximate personal monthly income?
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What are your total approximate personal monthly expense?
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How much do you usually spend on food in a normal month?
18
Were you an OSAP/financial aid recipient during the current semester?
Yes
No
Other
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While most Student Nutrition Program Food Pantry baskets are pre-packaged for you by SA staff, substitutions or alterations can be made for certain dietary restrictions.* This field is required.Do you have any dietary restriction? please note them below.
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Large
Normal
Small
Ok
Ok
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Please briefly describe the nature of your food insecurity?
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Ok
Ok
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I have spoken to _____ about my food insecurity in the past: (check all that apply)
Student Success Facilitator
International Office
Indigenous Services
Financial AID/OSAP
Student Wellness
My program coordinator/faculty
The Student Association/this form
SLC Spirtural Support
N/A or no one
Friend
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Do you have any comments on this process? Do you need additional support?* This field is required.
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Large
Normal
Small
Ok
Ok
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