College For Kids Submissions

The Pantry@Tunxis - Intake Form

Full Name(*)

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ID Number(*)

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CT State Email Address(*)

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Phone

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Age

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Gender

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Are you a veteran?

YesNo

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Number of children in your family in your household.(*)

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Number of adults in your family in your household, including you.

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Dietary Restrictions

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For you or other family members in your household.