Campus Cupboard

Campus Cupboard

Order Form
The Campus Cupboard is open to all currently registered students. Completion of this form is the first step to receiving food assistance. After you click Submit, Campus Cupboard volunteers will review this form (within 3 business days) and contact you to schedule a pickup appointment.

If you have any questions about this process or the Campus Cupboard in general, please contact us at campuscupboard@glenoaks.edu. Please note that our stock changes daily and we will try to fulfill your requests but may be limited by what we have on-hand.

You may request food assistance once every two weeks.

Thanks!
Name*

First NameLast Name
GOCC ID#*
Street Address (GOCC Student housing is 62237 Shimmel Rd, Centreville, MI 49032)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com

Indicate how many in your household in the following age groups

	Number
0-17
18-64
65+

Dietary Restrictions
Food Allergies
Foods You Do Not Like
Please choose 1-2 items per category. (Some items may not be available.)
Beverages

Almond MilkJuiceShelf-Stable Milk
Boxed Meals

Hamburger HelperTaco KitTuna Helper
Bread

Corn BreadWheat BreadWhite Bread
Breakfast

CerealOatmeal/Quick OatsPancake MixPancake Syrup
Canned Vegetables

CarrotsCornGreen BeansMixed VegetablesPeasTomatoes
Canned Fruit

ApplesauceFruit CocktailMandarin OrangesPeachesPears
Condiments

Hot SauceJelly, GrapeJelly, StrawberryKetchupMayoMustard
Dairy

Butter/MargarineCheese
Pasta/Ramen

Beef RamenBeefaroniChicken RamenMac & CheesePasta & SaucePasta Side DishesRavioliShrimp RamenSpagetti Rings
Protein

Baked BeansBlack BeansCanned ChickenEggs, LiquidGround TurkeyHamburgerHot DogsKidney BeansPeanut ButterSalmonTuna
Soup

Beef StewChicken NoodleCream of MushroomTomatoVegetable
Snacks

CrackersGranola/Snack Bars
Other

Canola OilInstant PotatoesPepperRiceSaltSloppy Joe MixSugar
Household Items

Cleaning WipesDish SoapFabric SoftenerLaundry DetergentSponge
Toiletries

ConditionerDeodorantFacial TissueRazorSanitary Napkins/PadsShampooSoap/Body WashTamponsToilet PaperToothbrushToothpaste
Other
Please Note: We want to be able to serve as many students as possible. Therefore, we ask that you refrain from requesting items that you have left over from previous visits. Thank you!
Please read the following statement carefully, complete the requested information and select submit below to receive food from this site. By submitting this form, I declare that I am (check all that apply):

In need of emergency food ORA participant in an income-based program such as WIC, CSFP, cash assistance (FIP) or food stamps ORIn a household where the income falls at or below posted Federal poverty Guidelines (see table below).

Household Size	Annual Income	Monthly Income	Weekly Income
1	$46,950	$3,913	$903
2	$63,450	$5,288	$1,220
3	$79,950	$6,663	$1,538
4	$96,450	$8,038	$1,855
Each Additional Household Member Add	$16,500	$1,375	$317

The food I receive from this pantry will be used by me and/or my household and will not be sold or misused in any way. The food I receive comes from a variety of sources and I accept the food “as is” and release the pantry, original donor, Food Bank, and Feeding America from any liabilities, damages, losses, claims, causes or actions and suits of law pertaining to the food I receive.
Should be Empty: