Student Pickup Form - Simmons College of KY

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DISCOVER
ABOUT SIMMONS
About Louisville’s Only HBCU
Kerner Commission 2.0
History of Simmons
Our President
Board of Trustees
Faculty and Staff
Alumni Survey
Accreditation
Outcomes and Performance
Institutional Effectiveness

About Louisville’s Only HBCU
Kerner Commission 2.0
History of Simmons
Our President
Board of Trustees
Faculty and Staff
Alumni Survey
Accreditation
Outcomes and Performance
Institutional Effectiveness
WHAT’S HAPPENING
News And Events
Jobs at Simmons

News And Events
Jobs at Simmons
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Athletics
Band
Housing

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Band
Housing
EXPLORE SIMMONS
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Campus Map
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Associates of Arts
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Sociology
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Applied Mathematics
Applied Psychology
Master of Science
Special Programs and Certificates
Dual Credit
Digital Teaching and Learning Center
Falcon Center for Academic Excellence
Executive Leadership Academy (ELA)
Black Film Institute
Jesse Louis Jackson Center for Racial Justice
Chapel Series

Associates of Arts
General Studies
Religious Studies AA
Bachelors of Arts
Business Entrepreneurship
Cross-Cultural Communication
Music Performance
Religious Studies
Sociology
Bachelors of Science
Computer Information Systems
Applied Mathematics
Applied Psychology
Master of Science
Special Programs and Certificates
Dual Credit
Digital Teaching and Learning Center
Falcon Center for Academic Excellence
Executive Leadership Academy (ELA)
Black Film Institute
Jesse Louis Jackson Center for Racial Justice
Chapel Series
ACADEMIC RESOURCES
Course Offering Schedule
Academic Calendar
Academic Catalog

Course Offering Schedule
Academic Calendar
Academic Catalog
STUDENT RESOURCES
UNCF Scholarship Opportunity
Library
Career Development
Technology Assistance
Elijah P. Marrs Honors College
Title IX
Policies, Procedures, and Reports
Student Forms
Talons’ Food Services
External Resources
COVID-19 Relief

UNCF Scholarship Opportunity
Library
Career Development
Technology Assistance
Elijah P. Marrs Honors College
Title IX
Policies, Procedures, and Reports
Student Forms
Talons’ Food Services
External Resources
COVID-19 Relief
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Pay Your Tuition And Fees
Financial Aid Consumer Information
FAFSA FAQ
1098T FAQ

Tuition And Fees
Pay Your Tuition And Fees
Financial Aid Consumer Information
FAFSA FAQ
1098T FAQ
DONATE
DONATE TO SIMMONS
Donate to Simmons
Case for Support
Support Simmons on Give For Good Day!

Donate to Simmons
Case for Support
Support Simmons on Give For Good Day!

DISCOVER
ABOUT SIMMONS
About Louisville’s Only HBCU
Kerner Commission 2.0
History of Simmons
Our President
Board of Trustees
Faculty and Staff
Alumni Survey
Accreditation
Outcomes and Performance
Institutional Effectiveness

About Louisville’s Only HBCU
Kerner Commission 2.0
History of Simmons
Our President
Board of Trustees
Faculty and Staff
Alumni Survey
Accreditation
Outcomes and Performance
Institutional Effectiveness
WHAT’S HAPPENING
News And Events
Jobs at Simmons

News And Events
Jobs at Simmons
STUDENT LIFE
Athletics
Band
Housing

Athletics
Band
Housing
EXPLORE SIMMONS
Schedule a Visit!
Campus Map

Schedule a Visit!
Campus Map
SHOP
Get Simmons Gear

Get Simmons Gear
LEARN
ACADEMIC PROGRAMS
Associates of Arts
General Studies
Religious Studies AA
Bachelors of Arts
Business Entrepreneurship
Cross-Cultural Communication
Music Performance
Religious Studies
Sociology
Bachelors of Science
Computer Information Systems
Applied Mathematics
Applied Psychology
Master of Science
Special Programs and Certificates
Dual Credit
Digital Teaching and Learning Center
Falcon Center for Academic Excellence
Executive Leadership Academy (ELA)
Black Film Institute
Jesse Louis Jackson Center for Racial Justice
Chapel Series

Associates of Arts
General Studies
Religious Studies AA
Bachelors of Arts
Business Entrepreneurship
Cross-Cultural Communication
Music Performance
Religious Studies
Sociology
Bachelors of Science
Computer Information Systems
Applied Mathematics
Applied Psychology
Master of Science
Special Programs and Certificates
Dual Credit
Digital Teaching and Learning Center
Falcon Center for Academic Excellence
Executive Leadership Academy (ELA)
Black Film Institute
Jesse Louis Jackson Center for Racial Justice
Chapel Series
ACADEMIC RESOURCES
Course Offering Schedule
Academic Calendar
Academic Catalog

Course Offering Schedule
Academic Calendar
Academic Catalog
STUDENT RESOURCES
UNCF Scholarship Opportunity
Library
Career Development
Technology Assistance
Elijah P. Marrs Honors College
Title IX
Policies, Procedures, and Reports
Student Forms
Talons’ Food Services
External Resources
COVID-19 Relief

UNCF Scholarship Opportunity
Library
Career Development
Technology Assistance
Elijah P. Marrs Honors College
Title IX
Policies, Procedures, and Reports
Student Forms
Talons’ Food Services
External Resources
COVID-19 Relief
APPLY
BECOME A FALCON TODAY!
APPLY
FINANCIAL AID
Tuition And Fees
Pay Your Tuition And Fees
Financial Aid Consumer Information
FAFSA FAQ
1098T FAQ

Tuition And Fees
Pay Your Tuition And Fees
Financial Aid Consumer Information
FAFSA FAQ
1098T FAQ
DONATE
DONATE TO SIMMONS
Donate to Simmons
Case for Support
Support Simmons on Give For Good Day!

Donate to Simmons
Case for Support
Support Simmons on Give For Good Day!

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LEARN
- Academic Programs
- Academic Resources
APPLY
- Apply Now!
- Finance
Donate
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Search

DISCOVER
LEARN
- Academic Programs
- Academic Resources
APPLY
- Apply Now!
- Finance
Donate
Contact Us
Employee Portal
Falcon.net
Search

RETURN TO TALONS’

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Step 1 of 3

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Student Name*

First Last

Student Email*

Enter Email Confirm Email

Student Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Total # of people in your household*

Children Ages 0-5*

Children Ages 6-17*

Adults Ages 18-59*

Seniors Ages 60+*

Veterans*

Simmons College of Kentucky Food Pantry Shopping List

Do you have any food allergies?*

YES

I am allergic to...*

Select All That Apply

GLUTEN and any products that contain it and the following – Wheat, Durum wheat, Semolina, Spelt, Kamut, Eincorn, Faro, Barley, Rye, Oat, Malt, Couscous

CRUSTACEANS and any products that contain it and the following – Amphipods, Barnacles, Crabs, Hermit Crabs, Crayfish, Isopods, Lobsters, Mantis Shrimp, Mussel Shrimp, Mysids, Sea Spiders, Shrimp, Prawns

EGGS and any products that contain it and the following – Albumin, Apovitellin, Cholesterol free egg substitute, Dried egg solids, Dried egg, Egg, Egg white, Egg yolk, Egg wash, Eggnog, Fat substitutes, Globulin, Livetin, Lysozyme, Mayonnaise, Meringue, Meringue powder, Ovalbumin, Ovoglobulin, Ovomucin, Ovomucoid, Ovotransferrin, Ovovitelia, Ovovitellin, Powdered eggs, Silici albuminate, Simplesse, Surimi, Trailblazer, Vitellin, Whole egg

FISH and any products that contain it and the following – Anchovies, Bass, Catfish, Cod, Flounder, Grouper, Haddock, Hake, Halibut, Herring, Mahi Mahi, Perch, Pike, Pollock, Salmon, Scrod, Swordfish, Sole, Snapper, Tilapia, Trout, Tuna

PEANUTS and any products that contain it and the following – Ground Nuts, Beer nuts, Monkey nuts, Nut meat, Arachis oil, Kernels, Peanut protein, Arachic oil, Arachis, Arachis hypogaea, Artificial nuts, Beer nuts, Boiled peanuts, Cold pressed, Extruded or expelled peanut oil, Crushed nuts, Crushed peanuts, Earth nuts, Goober peas, Ground nuts, Ground peanuts, Hydrolyzed peanut protein, Mandelonas, Mixed nuts, Nut pieces, Nutmeat, Peanut butter, Peanut butter chips, Peanut butter morsels, Peanut flour, Peanut paste, Peanut sauce, Peanut syrup, Virginia peanuts

SOYA and any products that contain it and the following – Soy flour, Soya Milk, Soya nuts, Bean curd, Edamame (soybeans in pods), Hydrolyzed soy protein, Kinnoko flour, Kyodofu (freeze dried tofu), Miso, Natto, Okara (soy pulp), Shoyu sauce, Soy albumin, Soy concentrate, Soy fiber, Soy formula, Soy grits, Soy milk, Soy miso, Soy nuts, Soy nut butter, Soy protein, Soy protein concentrate, Soy protein isolate, Soy sauce, Soy sprouts, Soya, Soya flour, Soybeans, Soybean granules, Soybean curd, Soybean flour, Soy lecithin, Soybean paste, Supro, Tamari, Tempeh, Teriyaki sauce, Textured soy flour (TSF), Textured soy protein (TSP), Textured vegetable protein (TVP), Tofu, Yakidofu, Yuba (bean curd), Soy oil, Soybean, Textured vegetable protein, Edemame, Bean curd, Vegetable starch, Vegetable gum

MILK and any products that contain it and the following – acidophilus milk, buttermilk, buttermilk blend, buttermilk solids, cultured milk, condensed milk, dried milk, dry milk solids (DMS), evaporated milk, fat‐free milk, fully cream milk powder, goat’s milk, lactose free milk, low fat milk, malted milk, milk derivative, milk powder, milk protein, milk solids, milk solid pastes, nonfat dry milk, nonfat milk, nonfat milk solids, pasteurised milk, powdered milk, sheep’s milk, skim milk, skim milk powder, sour milk, sour milk solids, sweet cream buttermilk powder, sweetened condensed milk, sweetened condensed skim milk,whole milk, 1% milk, 2% milk, butter, artificial butter, artificial butter flavour, butter, butter extract, butter fat, butter flavoured oil, butter solids, dairy butter, natural butter, natural butter flavour, whipped butter, Casein & caseinates — ammonium caseinate, calcium caseinate, hydrolyzed casein, iron caseinate magnesium caseinate, potassium caseinate, sodium caseinate, zinc caseinate, cheese (all types), cheese flavor (artificial and natural), cheese food, cottage cheese, cream cheese, imitation cheese, vegetarian cheeses with casein, Cream, Whipped cream, Curds, Custard, Dairy product solids, Galactose, Ghee, Half & Half, Hydrolysates — Casein hydrolysate, Milk protein hydrolysate, Protein hydrolysate, Whey hydrolysate, Whey protein hydrolysate Ice cream, Ice milk, Sherbet, Casein, Whey, Lactoalbumin, Lactulose, Lactoferrin, Lactoglobulin, Milk protein, Hydrolysate, Lactalbumin, Lactalbumin phosphate, Lactate solids, Lactyc yeast, Lactitol monohydrate, Lactoglobulin, Lactose, Lactulose, Milk fat, anhydrous milk fat, Nisin preparation, Nougat, Pudding, Quark, Recaldent, Rennet, Rennet casein, Simplesse® (fat replacer), Sour cream, Sour cream solids, Imitation sour cream, Whey, acid whey, Cured whey, Delactosed whey, Demineralised whey, Hydrolyzed whey, Powdered whey, Reduced mineral whey, Sweet dairy whey, Whey, Whey protein, Whey protein concentrate, Whey powder, Whey solids, Yogurt (regular or frozen), Yogurt powder

TREE NUTS and any products that contain it and the following – Almonds, Hazelnuts, Walnuts, Cashews, Pecan Nuts, Brazil Nuts, Pistachio Nuts, Macadamia or Queensland Nuts. Detailed List: – Almond, Almond paste, Anacardium nuts, Anacardium occidentale (Anacardiaceae) [botanical name, Cashew], Bertholletia excelsa (Lecythidaceae) [botanical name, Brazil nut], Carya illinoensis (Juglandaceae) [botanical name, Pecan], Cashew, Castanea pumila (Fagaceae) [botanical name, Chinquapin], Hazelnut, Juglans spp. (Juglandaceae) [botanical name, Walnut, Butternut, Heartnut] Karite (shea nut), Lichee nut, Litchi chinensis Sonn. Sapindaceae [botanical name, Lichee nut] Lychee nut, Macadamia nut, Macadamia spp. (Proteaceae) [botanical name, Macadamia nut/Bush nut], Mandelonas, Marzipan, Mashuga nuts, Nangai nuts, Natural nut extract (for example, almond extract), Nougat, Nu-Nuts®, Nut butters (e.g., Almond butter, Hazelnut butter, Brazil nut butter, Macadamia nut butter, Pistachio nut butter, Shea nut butter, Karike butter, as well as other nut butters), Nut meal, Nutella ®, Nutmeat, Nut oil (e.g., Walnut oil as well as other nut oils), Nut paste, Nut pieces, Pecan, Pigñolia, Pili nut, Pine nut, Pine nut (Indian, piñon, pinyon, pigndi, pigñolia, pignon nuts), Pinon nut, Piñon or Piñon nut, Pinus spp. (Pineaceae) [botanical name, Pine nut/piñon nut], Pistachio, Pistacia vera L. (Anacardiaceae) [botanical name, Pistachio], Pralines, Prunus dulcis (Rosaceae) [bontanical name, almond] Shea nut, Sheanut, Vitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut] Walnut (English, Persian, Black, Japanese, California)

CELERY and any products that contain it and the following – Celery seed, Celery leaf, Celery salt, Celariac or Celeriac, Celery stalk

MUSTARD and any products that contain it and the following – Mustard powder, Mustard seeds, Mustard flour, Mustard leaves, Mustard oil, Sprouted mustard seeds

SESAME and any products that contain it and the following – Sesame seeds, Sesame oil, Benne, Benne seed, Gingelly, Gingelly oil

SULPHITES and any products that contain it and the following – Sulphur, Sulphur Dioxide, Sulphite, Sulphites, Potassium bisulphite, Metabisulphite, Sodium bisulphite, Dithionite, Metabisulphite, Sulphiting agents, Sulphurous acid, E220 Sulphur dioxide, E221 Sodium sulphite, E222 Sodium hydrogen sulphite, E223 Sodium metabisulphite, E224 Potassium metabisulphite, E226 Calcium sulphite, E227 Calcium hydrogen sulphite, E228 Potassium hydrogen sulphite, E150b Caustic sulphite caramel, E150d Sulphite ammonia caramel

LUPIN and any products that contain it and the following – Lupine, Lupin flour, Lupin seed, Lupin bean

MOLLUSCS and any products that contain it and the following – Oysters, Snails, Squid, Scallops, Mussels, Clams and cockles, Abalone, Mussels, Octopus, Oysters

Please complete this section so we can better serve you:*

Please check all that apply:

I do not eat pork

I do not eat beef

I do not eat chicken

I do not eat cheese

I do not eat dairy

None of the above

SOUPS*

(check 1-2 items)

Tomato Soup

Chicken Noodle

Cream of Chicken

Chicken Broth

Beef Broth

Vegetable Beef

Cream of Mushroom

None of the above

PASTA / OTHER SIDES*

(Check 1-3 items)

Boxed Macaroni & Cheese

Single Serve Mac & Cheese

Chicken Flavored Ramen Noodles

Beef Flavored Ramen Noodles

Shrimp Flavored Ramen Noodles

None of the above

CANNED VEGETABLES*

(Check 1-3 items)

Carrots

Corn

Creamed Corn

Green Beans

Peas

Mixed Vegetables

Pork n Beans

Chile Beans

None of the above

CANNED FRUIT*

(check 1-2 items)

Mandarin Oranges

Pears

Peaches

Single Cup Mixed Fruits

Fruit Cocktail

None of the above

CANNED MEATS / SEAFOOD / PREPARED MEALS*

Tuna

Vienna Sausage

Beef Ravioli

Lasagna

None of the above

ASSORTED ITEMS*

(check 1-2 items)

Pasta Sauce

Alfredo Sauce

Jelly (Grape)

Jelly (Strawberry)

Peanut Butter

Popcorn (Microwavable)

None of the above

HYGIENE*

(check 1-3)

Toilet Paper

Toothbrush

Toothpaste

Bar Soap

Body Wash (for Males)

Razors for Males

Body Wash (for Females)

Razors for Females

Feminine Products

Deodorant (for Males)

Deodorant (for Females)

Detergent

Lotion

Towel Paper

None of the above

DRINKS*

(check 1-2 items)

Water Bottles

Gatorade

Tea bags

Coffee

None of the above

BREAKFAST ITEMS*

(check 1 or 2)

Individual Cereal (Assorted)

Breakfast Bars

Pop Tarts

Instant Oatmeal (Assorted)

Frozen Egg, Sausage, Cheese Croissant

None of the above

FROZEN FOOD ITEMS*

(check 1 or 2)

Pizza: Cheese

Pizza: Pepperoni

White castle Cheeseburgers

Regular Cheeseburgers

Veggie burgers (meatless)

Chicken and Fried Rice

Flatbread Chicken & Cheese Melt

None of the above

SCHOOL SUPPLIES

School supplies are available by request. Please contact Rebecca Gardner at rgardner@simmonscollegeky.edu if you are in need of school supplies

Please list other items you would like offered in the pantry:*

PLEASE enter "NONE" if you don't have anything to list at this time.

I am a band student and I understand that this box will be picked up at Axton hall day of pantry opening (Wednesdays)

Instructions for Student Orders

Please see below to schedule a pickup appointment. All available slots are shown. IF IT IS AFTER 9AM ON THE DAY BEFORE AN APPOINTMENT, PLEASE SCHEDULE AN OPEN APPOINTMENT FOR THE NEXT WEEK. ALL APPOINTMENTS SCHEDULED AFTER 9AM THE DAY BEFORE WILL BE CANCELED.

Schedule a Pickup Appointment!*

Name

This field is for validation purposes and should be left unchanged.