Please fill out the form below, when you press submit, make sure you see the confirmation page. Thank you! Meal Swipes Name* First Last Perm #*Email* Enter Email Confirm Email Have you received a meal ticket this academic year ('18- '19)?*YesNoDo you currently have a meal plan?*YesNoI would like to... learn more about the Food, Nutrition, and Basic Skills Program. learn more about CalFresh, regarding how I can get monthly benefits for food up to $194 a month. learn more about the AS Food Bank. Please select all that apply: Houseless or is experiencing housing instability (couch surfing, living in tent, ect..) Commute for more than 1 hour away for school & is on campus for multiple days overnight. Work 2 or more jobs or works 20 hours+ Has Children or dependents Graduate student without TA ship, fellowship, and employment Currently taking out loans How will this meal ticket benefit you this quarter? PLEASE SPECIFY, due to high demand, we will prioritize need.*Please read and place a checkmark in each box to indicate you are in agreement with the following statements. You MUST select all boxes. The RESALE of meal vouchers is Prohibited* I CERTIFY that I am currently enrolled at UCSB and that the information I have submitted on this form is true and secure. I RECOGNIZE that vouchers are for the recipient’s use only, and are subject to an awarding limit. Also, I understand that a voucher can only be used at UCSB Dining Commons. I am aware that vouchers cannot be exchanged for cash, nor will a remaining balance be given in change when used to make a purchase. I CERTIFY that I am the recipient of the voucher(s) indicated in the box below. I UNDERSTAND AND ACCEPT the obligations and conditions associated with the voucher and Swipes for Us program. I CERTIFY that I DO NOT currently have a meal plan. I UNDERSTAND that the meal tickets expire at the end of the quarter they are received.