Requests will be fulfilled as quickly as possible but are subject to availability.

PRIORITY IS GIVEN TO CLERMONT NORTHEASTERN STUDENTS, OTHER REQUESTS MAY BE FILLED IF SUPPLY ALLOWS.

SCHOOL SUPPLY REQUEST

Please enter the name of the adult or guardian in the family. You will need to fill out ONE FORM PER STUDENT

First Name

Last Name

Phone

(###)

###

####

STUDENT'S NAME

First Name

Last Name

GRADE

DISTRICT / SCHOOL

BACKPACK NEEDED?

If a backpack was issued last year, we cannot supply a backpack this year unless there is a special case

If High School Student, Please enter Schedule

Please enter any special courses such as advanced math courses, art, etc.

PICKUP METHOD

I AM A CURRENT PANTRY CLIENT

If you are or have been a pantry client in the past year, please select YES. If not, we will send you a link to fill out.

YES