First-Time User Application

If you are using the Trojan Food Pantry for the FIRST TIME, you must fill out First-Time User Application form.

This information is for data purposes only. The information you provide is confidential. After filling out this form, you must go back and fill out the Food Request Form as well.

First-Time User Application

Name(Required)

First Last

UA Little Rock T-Number(Required)

Email(Required)

Age(Required)

Race(Required)

I identify my gender as:(Required)

Classification(Required)

If you are a student: Are you full-time or part-time?

If you are a student: Are you a first generation college student?

If you are a student: Are you an international student?

If you are a student: Do you have a meal plan at UA Little Rock?

How many hours do you work per week (if any)?(Required)

What county do you live in?(Required)

What type of housing do you currently have?(Required)

Do you have any dependents?(Required)

Please select the age ranges of your dependents:

0-17

18-59

60+

How many dependents do you have age 0-6?(Required)

How many dependents do you have age 7-17?(Required)

How many dependents do you have age 18-24?(Required)

How many people in your household are employed? (Please note that if you are a student living in the dorm, your household size will always be only yourself.)(Required)

Are you currently on SNAP (Supplemental Nutrition Assistance Program) benefits?(Required)

Are you interested in applying for SNAP benefits?(Required)

*I acknowledge receipt of free food from the University of Arkansas at Little Rock Trojan Food Pantry. I understand this is a gift and not a reoccurring obligation by the University of Arkansas at Little Rock or the Community Connection Center. I further understand and agree that by accepting this donated food I freely and voluntarily, with full knowledge, hold harmless and in no way liable or responsible for the quality, condition or packaging of the food, the University of Arkansas at Little Rock, its officers, agents, employees, students, volunteers, and food suppliers.(Required)

First-Time User? Fill Out the Application

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