Fillable PATRIOT PANTRY New User Intake Form Name Patriots (University of Texas at Tyler)

Fill Online, Printable, Fillable, Blank PATRIOT PANTRY New User Intake Form Name Patriots (University of Texas at Tyler) Form

Use Fill to complete blank online UNIVERSITY OF TEXAS AT TYLER pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PATRIOT PANTRY New User Intake Form Name Patriots (University of Texas at Tyler)

On average this form takes 13 minutes to complete

The PATRIOT PANTRY New User Intake Form Name Patriots (University of Texas at Tyler) form is 3 pages long and contains:

  • 0 signatures
  • 13 check-boxes
  • 45 other fields

Country of origin: US
File type: PDF

U.S.A. forms for University of Texas at Tyler

BROWSE UNIVERSITY OF TEXAS AT TYLER FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
PATRIOT PANTRY
New User Intake Form
CLIENT INFORMATION
Name
Patriots E-mail
Student ID Number
Age Under 18
18-24
25-34
35-44
45+
STUDENT/FACULTY/STAFF/COMMUNITY INFORMATION
Which are you? Student
Faculty/Staff
Community Member
What type
of student
are you?
Full
Part
If you're a student,
what is your
classification?
Freshman
Sophomore
Junior
Senior
Graduate Student
HOUSEHOLD INFORMATION
Where do you live? On-campus
Off-campus
How many people
live in your
household
(including you)?
If on-campus, which
residence?
O-Hall
University Pines
Patriot Village
Liberty Landing
Victory Landing
How many people in
your household are
under 18 (including
yourself)?
What is your
hometown?
EMPLOYEMENT INFORMATION
Are you employed? Yes
No
Where do you
work?
On-campus
Off-campus
Employment Status Full-Time
Part-Time
How many people in
your household are
employed (including
yourself)?
BENEFITS INFORMATION
Do you currently
receive any benefits
(SNAP, WIC, etc.)
Yes
No
Would you like
to receive
information
about benefits?
Yes
No
Would you like to
receive information
about on-campus
resources? If so,
please select all that
you're interested in:
Counseling
Student Accessibility
Career Success
Health & Wellness
Students in Recovery
Student Money Management
HOW DID YOU HEAR ABOUT US?
Method flyer/poster e-mail
faculty/staff friend
student organization social media
other
TERMS AND CONDITIONS: Please read the following before signing.
I understand that the food from the UT Tyler Patriot Pantry may only be distributed to
a current UT Tyler student for him/herself and his/her dependents (spouse and
children under the age of 18). I also understand that the UT Tyler Patriot Pantry has
been donated to from various on-campus and off-campus partners, and that none of the
parties or groups involved in the program make any warranties as to the quality of the
food and non-food items or its value for any particular purposes. Myself and my family
release UT Tyler and its off-campus partners from any and all responsibility concerning
the quality and safety of the UT Tyler Patriot Pantry food and non-food items.
I understand that the UT Tyler Patriot Pantry operates on limited fund and in support
of others, and not as a service of UT Tyler. I will not abuse the services of the UT Tyler
Patriot Pantry. I will only request and take the items that I reasonably expect myself
and/or my dependents to use.
I understand and
agree to the terms
and conditions:
Yes
No
Signature:
Date:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PATRIOT PANTRY New User Intake Form Name Patriots (University of Texas at Tyler)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document