Meal Swipes Application Contact Information Name First Name Last Name Baylor ID Number Email Address Phone Address Address, Line 2 City State - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Academic Information Current Enrollment Status - Select - Full-time Part-time Are you and International student - Select - Yes No Current Year of Study - Select - Freshman Sophomore Junior Senior Graduate Meal Swipe Information Have you previously applied for Meal Swipes - Select - Yes No Are you currently receiving any form of financial aid? - Select - Yes No (e.g., FAFSA, scholarships, etc.) Reason for requesting Meal Swipes Financial hardship Limited access to meal options Health or dietary restrictions Living off-campus but facing financial constraints Other Other Reason for Requesting Meal Swipes Have you Experienced any of the following challenges Food insecurity Limited access to grocery stores or meal plans Difficulty affording campus dining Other Other Challenges Experienced Do you have any dietary restrictions or preferences that should be considered when allocating meal swipes? Dietary Restrictions - Select - Yes No List of dietary restrictions Supporting Information Please describe why you believe you qualify for meal swipes at this time The following questions are for data purposes only and do not impact your ability to access the Meal Swipe Program. How often has the following statement been true for you this semester so far or last semester? 'The food I bought didn't last, and I didn't have money to get more Let us know if the statement is true - Select - Never True Sometimes True Often True Always True Other Other Explanation Have you been skipping meals or eating less than you need because you didn't have enough money to buy food? Let us know if you have been skipping meals - Select - No Sometimes Often Always Other Other Explanation for Skipping Meals So far this semester (or last semester), have you ever had to go a whole day without eating because you didn't have enough money to buy food? Let us know if gone a whole day without eating - Select - I'm Never Struggling Only once so far Two or three times This happens regularly Other Other Explanation for not eating Do you have the resources to purchase the materials you need (laptop, calculator, textbooks, etc.) for classes this semester? Do you have the resources to purchase needed materials? - Select - I'm good I'm struggling I need help I'm in distress Other Other explanation about materials resources In the last 30 days, did you have difficulty paying your rent or mortgage? Do you have difficulty paying your rent/mortgage - Select - In the last 30 days, did you have difficulty paying your rent or mortgage? I'm struggling I need help I'm in distress I'm in crisis Other Other explanation about paying rent/mortgage Do you have reliable transportation to school, work, and/or basic needs resources Let us know if you have reliable transportation - Select - I'm good I'm struggling I need help I'm in distress I'm in crisis Other Other Explanation for reliable transportation Let us know if you have difficulty accessing healthcare Do you have difficulty accessing healthcare? - Select - I'm good I'm struggling I need help I'm in distress I'm in crisis Other Other explanation concerning healthcare Let us know if you have difficulty accessing mental healthcare Do you have difficulty accessing Mental healthcare - Select - I'm good I'm struggling I need help I'm in distress I'm in crisis Other Other explanation concerning mental healthcare Let us know if you are a parent or caregiver. Are you a parent or caregiver - Select - Yes No Other Other caregiver explanation How did you hear about the Meal Swipe Program Is there anything else you'd like us to know about you