Tishomingo Public Schools

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School Pantry Referral Form

The school pantry is only for students who you feel are chronically hungry. The program provides food for students who might otherwise not have food in the evening and over the weekend when they cannot eat at school.

Please Fill Out The School Pantry Referral Form Below

Student's Name:

Date:

Referring Staff:

I agree that to the best of my knowledge that the student named above is chronically hungry and needs food. This student will benefit from the school program provided by the Regional Food Bank of Oklahoma.

Coordinator's Signature

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