Pacer Pantry Request Form

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Thank you for using the Pacer Pantry! We will attempt to have your order filled within 24 hours of receiving it however, some orders may be filled outside of this timeframe. You will receive an email when your order is ready for pick-up on the front porch of Joyner House. Your order will be labeled with your Peace student ID number. You will have 5 days from the time of notification to pick up your order before items are return to the Pantry stock.

Email *

Record my email address with my response

Name *

Student ID Number *

Cell Phone Number *

Year in school

First year

Sophomore

Junior

Senior

Clear selection

Do you live in Peace Residential Housing? (this includes VG)

Yes

Clear selection

Are you enrolled through Peace Online (School of Professional Studies) *

Yes

Do you have access to a kitchen, stove, can opener, microwave? (Check the items that you DO have access to) *

Kitchen

Stove

Can Opener

Microwave

Required

Food Allergies or Sensitivities

*this includes things such as tree nut allergies, gluten intolerance, lactose intolerance, etc.*

NOTICE *

Please note that any orders placed after 12pm on Fridays is NOT guaranteed to be filled before the weekend.

I understand

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