Curbside Pick up Food Order Form

General Information

Required
Name
University Email
Date of Birth (MM/DD/YYYY)
Will someone other than you be picking up your order? If yes, please provide their name below.
How many adults (over the age of 18) are in your household who are in need of food?
How many children are in your household who are in need of food?
List dietary restrictions/special requests (Ex. Do you have access to a microwave, stove?) Please be as detailed as possible so we can give you the best food for you and your household. 
What items would you like to pick up through our curbside service?

Please note that you may receive dry/household goods once a month and produce items weekly.
Are you a MU Health Care employee?