Pirate Pantry Ordering Form
For April 17th Distribution
Name
First Name
Last Name
ID
I am a:
Commuter (living off campus)
Residential (living on campus)
Copley Quad Room Number
Please list any food allergies
Food Requests
Please choose up to 3 items total per category. Pantry staff will do their best to accommodate your requests
Dairy(choose up to 3 items total from the choices below)
1
2
3
White Milk
Chocolate Milk
Non-Dairy Milk
Velveeta Cheese
Protein (choose up to 3 items total from the choices below)
1
2
3
Peanut Butter
Beans (1 can- variety)
Tuna (can)
Chicken (can)
Re-fried Beans
Chef-Boy-R-Dee Meal
Ham
pork and beans
Pork (canned)
Beef (canned)
Vienna Sausages
red beans and rice
corned beef hash
Soups/Chili (choose up to 3 items total from the choices below)
1
2
3
Vegetable
Tomato
Chicken Noodle
Chili
Chunky Soup- staff pick
chicken and rice soup
Grains/Carbs (choose up to 4 items total from the choices below)
1
2
3
4
Mac and Cheese
Top Ramen
Box of Cereal (counts as 2)
Pasta (counts as 2) - sauce available under Vegetable section
Rice (counts as 2)
Saltine Crackers
Packaged Flavored Rice
Packaged Flavored Pasta
Oatmeal
Instant Mashed Potatoes
Tortilla
Hashbrown potatoes (add water and pan fry)
2 Whole potatoes (raw)
quinoa and brown rice pack
brown rice pack
rice -r- roni box
Vegetable (choose up to 4 items total from the choices below)
1
2
3
4
Green Beans
Corn
Carrots
Peas
Can of Pasta Sauce
can mixed vegetables
Fruit (choose up to 3 items total from the choices below)
1
2
3
Fruit cup
Grape Jam (counts as 3)
Applesauce
Strawberry Jam (counts as 3)
can of peaches
Ot
her-Staff pick
Snacks (choose up to 5 items total from the choices below)
1
2
3
Granola Bars
Potato Chips
Beef Sticks
Other-Staff Choice
Other (choose up to 3 items total from the choices below-based on availability )
1
2
3
Candy
Sports Drinks
Tea
Salsa
Special Requests - Food (Pantry Staff will do our best to satisfy requests)
Hygeine
1
Toothpaste
Toothbrush
Deodorant
Shampoo
Conditioner
Soap
Tampons
Sanitary Pads
Laundry Soap
razor
body wash
shaving cream
condoms
dish soap
Other Hygiene Requests
Any other Requests or support needed?
Submit
Should be Empty: