Wellness Bank Request Form Submission Date *2123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419230102030405060708091011120102030405060708091011121314151617181920212223242526272829303132Today's DateFirst Name *Last Name *SAIT Student Email *SAIT Student ID *Phone *Program of Study *Student Status *DomesticInternationalCourse Load *Full-TimePart-TimeHow did you hear about the Saitsa Wellness Bank? *Saitsa.comSocial Media (IG, FB, TikTok, etc.)On-Campus AdvertisingWord of MouthSearch EngineOtherOther Reason for request *Main source of income? *i.e. Work, Loans, GrantsNumber of family members who financially depend on you (not including yourself) Items Requested *Hand SoapToothbrushToothpasteFlossShampooConditionerBody SoapMen's DeodorantWomen's DeodorantFace WashLotionToilet PaperBand-AidsCondomsTamponsSanitary PadsPanty LinersToilet CleanerDish SoapDish SpongesMulti-Purpose CleanerLaundry DetergentDryer SheetsSelect up to 10 itemsIs there anything else we should know? Acknowledgement 1 *I acknowledge that further information might be requested (i.e. financial payments or paystubs).Acknowledgement 2 *I acknowledge that this program is intended to support students in need and that abusing this program will result in a significantly negative impact on those who need the support.Acknowledgement 3 *I acknowledge that abusing this program will result in loss of access to the Wellness Bank.Acknowledgement 4 *I acknowledge that the Saitsa Wellness Bank may take 1-2 weeks to process my request. An email will be sent from Saitsa with further information on this application.Terms & Conditions *I agree to the Terms & Conditions and confirm that all the information submitted on this form is true.1. You must be a current SAIT student with a valid SAIT student ID. 2. The information in this form is used for statistical purposes only, and will be kept confidentialWebsiteSubmit
