Meal Replacement Order Form

Student Name and Barcode Number______________________ Dinner or Lunch____________

Please indicate your selections in each category and day below. If for any reason you need to cancel your meal please call extension 6360 and leave a message before 7:00 am. If you fail to pick up your meal three times with no cancellation notice you may lose your privilege for the entire semester. If you have any questions please feel free to contact either Mike, or Caroline. Thank You. Each lunch can consist of the following choices.

OPTION #1

Choice of Healthy Choice Microwaveable Meal (Monterey Chicken, Manicotti Frommagio, Beef Tips Portobello)

Piece of Fresh Fruit (Apple, Orange, Banana)

Canned Pop/Bottle Water

OPTION # 2

Sandwich/ Wrap (Made up of Choices Below)

Side Dish

Piece of Fresh Fruit (Apple, Orange, Banana)

Cookie or Brownie

Canned Pop/Bottle Water

OPTION #3

Large Salad (Caesar, Chicken Caesar, Chef, Garden) with Choice of Dressing

Side Dish

Piece of Fresh Fruit (Apple, Banana, Orange)

Cookie or Brownie

Canned Pop/Bottle Water

SANDWICH/WRAP OPTIONS

Bread Condiments Meat Cheese Specialty

White Mayo Ham American Buffalo Chicken Wrap

Wheat Mustard Turkey Swiss Turkey Club Wrap

Italian Ketchup Egg Salad Cheddar Italian Sub

Wh. Grain Relish Tuna Salad Provolone

SIDE DISH OPTIONS

Side Salad w/ Dressing Chips

Side Caesar Pretzels

Veggies and Dip Cottage Cheese

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY
Estimated Pick Up Time
Main Option
Side Dish
Fruit
Dessert