The Ann B. Clark Co-op
Which school are you affiliated with?
Goodwin University
CTRA
RMS
Are you University faculty or staff?
Faculty
Staff
First Name
Last Name
Email
Day and Pick-Up Window
Select a Day and Pick-Up Window
Wednesday 11 a.m.-1 p.m.
Wednesday 1-3 p.m.
Thursday 11 a.m.-1 p.m.
Thursday 1-3 p.m.
Household Size
Select Household Size
0
1
2
3
4
5
6
7
8
9
10
How many in your household are under 18?
Select household members under 18
0
1
2
3
4
5
6
7
8
Are you enrolled in our TEFAP program?
Yes
No
Does anyone in your household have food allergies?
Yes
No
Describe allergies
If you are human leave this field blank
