Version 2/17/2020
Green and Gold Cupboard Request Form
T Number: _________________________ Date: _________________________
Number in household for whom you need food: ____Adults ____Children
DIETARY RESTRICTIONS/ALLERGIES:____________________________
I have access to (check all that apply): __Stove Top __Oven __Microwave __Can Opener __Refrigerator __Freezer
For each category, mark your top 3 preferences. Some items may not be available.
SOUP
Chicken Noodle
Tomato
Cream
Broth (beef or chicken)
Vegetarian
Chef Boyardee
Other: _______________
CANNED MEAT
Tuna
Chicken
Ham
Vienna Sausages
Potted Meat
CANNED VEGETABLES
Green Beans
Peas
Corn
Carrots
Tomatoes
Spinach
Mixed
Potatoes
Other: _______________
BEANS
Baked Beans
Pork and Beans
Black Beans
Refried
Blackeyed Peas
Pinto
Kidney
Other: _______________
CEREAL
Raisin Bran
Cheerios
Frosted Flakes
Oatmeal
Other: _______________
FROZEN CHICKEN
STRIPS
SNACKS
Popcorn
Pudding Cups
Applesauce
Crackers
MACARONI & CHEESE
PEANUT BUTTER
Creamy
Crunchy
Natural
JELLY
Grape
Strawberry
Other: _______________
CANNED FRUIT
BAKING/CONDIMENTS
Ketchup
Mayonnaise
Cooking Oil
Frosting
Cake Mix
Pancake Mix
Sugar
Flour
Other: _______________
BEVERAGES
Coffee
Tea
Milk (Shelf-Stable)
Other: _______________
RAMEN
Chicken
Beef
Shrimp
Other: _______________
PASTA
PASTA SAUCE
RICE
POTATOES
Mashed
Scalloped
BOXED/PACKAGE MEALS
Beef Helper
Tuna Helper
Rice Meals
Noodle Meals
HYGIENE/OTHER
Deodorant
Toothbrush
Toothpaste
Shampoo
Conditioner
Soap
Laundry Detergent
Other: _______________
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EXTRA ITEMS NOT ON THIS LIST: _______________________________________________________
PLEASE NOTE: We want to be able to help as many students and staff members as possible. If you have
items left over from your last visit, please do not request them until you run out. Thank you.