Request Help from the Food Pantry (JWCC Regional Centers)

Food pantry assistance is available for JWCC students and their families. You do not need to fill out this form if you are picking up from the main Quincy Campus.

Name Name First Last
J# (your student ID number, e.g. J000XXXXX)
Cell Phone Cell Phone - ### - ### ####
JWCC Email
Which JWCC regional center would you like to pick up from?
How many people are in your household?
What kind of assistance do you need?

What kind of assistance do you need? Food Toiletries Both food and toiletries
Any allergies?

Any allergies? Yes No
Please list the allergies.
What food are you in need of? Check all that apply:

What food are you in need of? Check all that apply: Pasta Canned Tuna Canned Chicken Canned Fruit Canned Vegetables Cereal
What toiletries are you in need of? Check all that apply:

What toiletries are you in need of? Check all that apply: Deodorant Shampoo Soap Toothpaste
If you have any additional needs, please let us know.