Griffy’s Grocery Intake Form

Are you ready to start grocery shopping? This intake form can be filled out when you come to shop or, for your convenience, in advance. When you check in, please bring your MMC student ID. The information you give us will be used to better understand how we can provide the necessary services to you and future students using Griffy’s Grocery: The MMC Student Food Pantry. The information collected in this intake form will be kept private.

While all of the information being asked in the form is helpful to us in running The Grocery, not all questions are required to complete the intake form. Only those questions marked with an asterisk * are required to complete the form.

The intake form should be completed the first time a shopper shops each semester.

What do I need to do to use Griffy’s Grocery: The MMC Student Food Pantry?

Complete intake form, either in advance or at check-in desk.
Show valid student ID card to volunteer staff .
Select items from The Grocery–the number of items varies based upon inventory that is currently available.

Intake Form

All fields marked with asterisk (*) are required.

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First Name*

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Last Name*

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Student ID Number*

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Class Standing

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Is this your first visit to Griffy’s Grocery: The MMC Student Food Pantry?

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With which gender identity do you most identify?

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Please select the race/ethnicity group with which you identify with the most.

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What term best describes your sexual orientation?

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Do any of the following apply to you? Please check all that apply.

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What is your current living situation?*

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How did you hear about Griffy’s Grocery: The MMC Student Food Pantry? Please select all that apply.

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Please select the response which best applies.

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What is your course load?

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What do you have access to? Please check all that apply.

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I understand that food distributed at Griffy’s Grocery: The MMC Student Food Pantry has been donated 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 or its value for any particular purposes. Some of the food distributed at The Grocery has surpassed its “best by” consumption date. This date is for peak flavor and quality, and is not a purchase by or safety date.*

I understand

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I voluntarily accept the food “as is.” By my checking below that I understand, my family and I release Griffy’s Grocery: The MMC Student Food Pantry at Marymount Manhattan College, and the original donor from any liability for harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and will not sue the released parties with respect to such harm or losses.*

I understand

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I understand that Griffy’s Grocery: The MMC Student Food Pantry operates on limited funds and in support of others, and not as a service of Marymount Manhattan College. I understand that there is no guarantee as to the amount or type of food or non-food products to be provided. I will not abuse the services of The Grocery. I will only request and take the items that I reasonably expect myself and/or my family to use.*

I understand

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Griffy’s Grocery Intake Form

Intake Form

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