Community Cupboard Form

Langara Student ID Number*

(the Community Cupboard program is only open to Langara students)

Name*

As listed on your myLangara Account (to verify ID above)

First Last

Email*

Have you used this service before?*

Yes
No

If yes, when?

Program of Study

Are you enrolled:

Full-time
Part-time

Are you currently on student loans?

Yes
No

Are you a parent?

Yes
No

If so, number of children

Are you supporting other family members?

Yes
No

If so, how many

In order for us to stock necessary food items, please list the top five that you need:

By submitting this form, you consent that your student number will be used by Langara College to report internally on Community Cupboard use, demographic information, and other metrics.*

Yes, I consent
No, I do not consent

By submitting this form, you consent that Langara College can share the information contained in your Langara file (eg, demographic information such as international/domestic student status) with prospective and current donors to support fundraising efforts.*

Yes, I consent
No, I do not consent

The Langara Community Cupboard Program collects the personal information on this form under the authority of the College and Institute Act, section 41.1 and in compliance with the Freedom of Information and Protection of Privacy Act, section 26(c) for the purpose of providing on-campus food bank services to students. With your consent, the College will use/share demographic information for internal reporting and to support fundraising. For questions about the collection, use, and sharing of your personal information, contact Financial Aid - 604.323.5376