Upward Bound Food Selection Form

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This form was created to help us determine which students on our roster have special dietary needs.

What is your first and last name? *

Which program are you in? *

CLASSIC (Moreno Valley, Perris, Rubidoux)

OASIS (Banning, Norte Vista, Ramona)

RCJ (Bloomington, Colton, Eisenhower)

Which selection best describes your eating preference? *

Traditional Meat Products (beef, chicken, ham, turkey, etc.)

Vegan

Vegetarian

Pescatarian (The substitution of fish over beef, chicken, ham, etc.)

No Preference

Do you have any food allergies (peanuts, etc.)? If yes, please indicate the food items below. If no, please type "N/A" in the field below. *

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