Feed U Pantry First Time Visitor Form Full Name * Number of People in Household Zip Code * Email Federal Poverty Income Guidelines 7/1/24-6/30/25 Family Size & Monthly Income: 1 Person: $2,322 2 People: $3,152 3 People: $3,981 4 People: $4,810 5 People: $5,640 6 People: $6,469 7 People: $7,299 8 People: $8,128 I certify my total household income is at or below the stated amount for my household size * I certify How did you hear about the Feed U Pantry? Word of Mouth Social Media Internet Flyer Newspaper OtherOther Please read and sign the following: I understand that the food from University of Utah Feed U Pantry may only be distributed to a current University of Utah student for themselves and their dependents (spouse and children under the age of 19). I also understand that the University of Utah Feed U 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 University of Utah Feed U Pantry 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 and my family release the University of Utah and its off-campus partners from any and all responsibility concerning the quality and safety of the University of Utah FEED U Pantry. * I understand that University of Utah Feed U Pantry operates on limited funds and in support of others, and not as a service of the University of Utah. I will not abuse the services of the University of Utah Feed U Pantry. I will only request and take the items I reasonably expect myself and/or my dependents to use. Submit If you are human, leave this field blank. Δ
