register today It’s easy! Just fill out the form below, come in, and show us your Access Card. Hope to see you soon! AS Food Bank Registration "*" indicates required fields What is your preferred language?*EnglishSpanishMandarinFrenchArabicRussianOther (Please Specify)If you answered "Other", please specify your preferred language. Name* First Last Perm # (7-Digit)* Email* Phone Today's Date* MM slash DD slash YYYY UCSB email* Year in School*1st2nd3rd4th5th6th +Grad StudentAge* Check ALL that you identify with:* American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White Hispanic/Latin@ Other Decline to state Gender*FemaleMaleTrans FemaleTrans MaleNon-BinaryOtherDecline to StateCheck all that apply:* Undergraduate Student Graduate Student International Student Single (Not Married) Married/Domestic Partners Have Children/Dependents Currently Taking Out Loans Currently Receiving Financial Aid Currently Receiving CalFresh Currently Employed Houseless (couch surfing, living in a vehicle, etc) Chronically homeless: either a) in a shelter or on the street in the entire last year b) in the shelter or on the street four times in the last three years If you do have dependent(s), what is your family size (including yourself)?If you do have dependent(s), are you a female head of the household? Yes No Are you a veteran?* Yes No Have you used our pantry before?* Yes No Yes: I am re-registering because I have not re-registered since July 1st No: This is my FIRST time ever using the AS Food Bank List any dietary preferences or requirements. Please tell us if you follow any unique dietary patterns, food preferences, or have any dietary restrictions. How often will you visit? Please tell us how often you plan on visiting or have in the past. If you are a newly registered user, you may guess. How did you hear about us?*From a friendFrom staff or facultyFrom a peer advisorOnlineFrom orientationOther (explain below)How did you hear about us? (explain)Additional Comments Δ