First Time Campus Cabinet User Application

For Campus Cabinet Use:

Date Received: _______________________ CC ID#: _______________________________ Showed NWOSU ID_________ Showed Proof ________

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(For best results, please fill out this form using the Google Chrome Browser.)

The information provided from this form only will be seen by the staff responsible for the food pantry and used for internal reporting. Personal information will be kept confidential and only statistical information will be used. Information given on this application will not affect your use of the food pantry.

Students and employees utilizing the Campus Cabinet Food Pantry must show a valid Northwestern ID at the pantry. IDs are available via Student Services, first floor Fine Arts Building.

A Campus Cabinet ID Number and Card will be issued to you upon your first visit. You will continue to use this card during your time at Northwestern, along with your Northwestern ID.

Please submit this form by Monday prior to the Wednesday you visit the pantry.

The Campus Cabinet will be open each Wednesday from 5 to 7 p.m. If you absolutely cannot come at that time, please contact Angelia Case at (580) 327-8577 or arcase@nwosu.edu to make an appointment.

Personal Information

Primary Campus Location *
Ethnicity (check all that apply) *
Campus Status (choose all that apply) *
Are you a first-generation student? (A first generation student is someone who neither their parents nor grandparents attended college.) *

Household Information

Do you have a vehicle or access to transportation? *
Do you receive/use financial aid/scholarships? (choose all that apply) *
Employment Info: *
Government assistance benefits you or someone in your NWOSU residence receive? (choose all that apply) *
Do you identify with any of the following (choose all that apply) *
Has a lack of funds for food caused you to do any of the following within the last year? *

List needs, other than food, that you would like information on ( counseling, food stamps, shelter, other forms of assistance, etc.) so we can try to help provide contact information for these areas.

By checking this box, it will serve as my electronic signature. I acknowledge that I will be receiving free food from the Campus Cabinet. I understand this is a gift and not a reoccurring obligation by the university, Campus Cabinet or fiscal sponsor. I further understand and agree that by accepting this donated food, I freely and voluntarily, with full knowledge, hold harmless and in no way liable or responsible for the quality, ingredients used in, condition or packaging of food, Northwestern, its officers, agents, employees, students, donors, volunteers and food suppliers. I also acknowledge that I may visit the Campus Cabinet one time per week.

 Acceptance of Free Food and Waiver of Liability

Northwestern Oklahoma State University

709 Oklahoma Blvd., Alva, OK 73717
Phone: (580) 327-1700

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University. All Rights Reserved.

Mission Statement

Northwestern Oklahoma State University provides quality educational and cultural opportunities to learners with diverse needs by cultivating ethical leadership and service, critical thinking and fiscal responsibility.

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