Emergency Food Security Intake Form

Semester

Year This question requires a valid number format.

1. Contact Information *This question is required.

First Name *This question is required.

Last Name *This question is required.

Date of Birth *This question is required.

Student Number *This question is required. Please double check that you have entered the correct number as it will impact your eligibility if incorrect.

Preferred Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

3. What is your country of origin? *This question is required.

3. Food Insecurity Factors
*This question is required.To assist TRUSU in assessing food insecurities for TRU students generally please complete the following questions. Your answers will remain confidential.

Please share the emergency incident in your life that has caused your food insecurity. *This question is required.

How many dependants do you have? *This question is required. if none please enter 0 This question requires a valid number format.

How many people are living in your household? *This question is required. including yourself This question requires a valid number format.

Are you receiving student loans? *This question is required.

Are you a full-time or part-time student? *This question is required.

Are you employed? *This question is required.

What is your average monthly income? *This question is required. This question requires a valid number format.

Roughly how much do you spend on housing each month? *This question is required. This question requires a valid number format.

TRUSU offers Emergency Bursary Aid for students in need, have you applied to that program? *This question is required.

How did you hear about this service? *This question is required.

Is there anything else that you would like us to know? *This question is required.