[TEST] Isolation Next Day Meal Order Form
Step
1
of
2
50%
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Todays Date
MM slash DD slash YYYY
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timestamp
(Required)
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Date For
(Required)
Please submit your order before 4pm in order to select your food options. All individuals who submit an order (even those who submit after 4pm who receive a default meal) will be sent a confirmation email. Eligible individuals who do not submit an order at all will still receive a default meal, but will not be sent an email confirmation.
Please Note: This is for isolation individuals only.
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Please enter your UniversityID (no spaces or dashes) if you have a BruinCard, otherwise, please enter your first name, last initial and room number (Example: Joe Bruin in room 9, JOEB9) in the field below.
(Required)
Selections for tomorrows delivery
Make your meal selections from the options below.
Please email any menu or delivery questions to:
MealDeliveries@ha.ucla.edu
.
Food Allergies
(Required)
Do you have any food allergies?
Yes
No
Please list your food allergies here
(Required)
Please note: This online menu does NOT change dynamically to reflect your allergies. Please list your food allergy and submit the form marking your meal choices and UCLA Housing will substitute as necessary for any items that contain the allergen(s) listed. Please only list food allergies and dietary restrictions, not preferences. Thank you!
Breakfast Selections
Breakfast Beverage Selection
(Required)
Dasani Bottled Water
SToK Black Cold Brew Coffee with Non Dairy Creamer on Side and Sugar on Side
(vegetarian, dairy)
Vanilla Protein Shake
(dairy)
Chocolate Protein Shake
(dairy)
I do not want this selection
Breakfast Entrée Selection
(Required)
Greek Yogurt with Dried Fruit Granola
(dairy, vegetarian, tree nuts, wheat, gluten)
Cheerios with Low Fat Milk
(dairy, low carbon)
Cheerios with Soy Milk
(vegan, soy, low carbon)
Raisin Bran with Low Fat Milk
(wheat, gluten, low carbon, dairy)
Raisin Bran with Soy Milk
(wheat, gluten, vegan, low carbon, soy)
Corn Flakes with Low Fat Milk
(wheat, gluten, low carbon, dairy)
Corn Flakes with Soy Milk
(wheat, gluten, vegan, low carbon, soy)
I do not want this selection
Breakfast Pastry Selection
(Required)
Apple Turnover
(vegetarian, wheat, soy, gluten)
Butter Croissant with Butter & Strawberry Preserve
(vegetarian, dairy, egg, wheat, soy, gluten)
Blueberry Muffin with Butter & Strawberry Preserve
(vegetarian, dairy, egg, wheat, soy, gluten, tree nuts)
Chocolate Chip Muffin with Butter & Strawberry Preserve
(vegetarian, dairy, egg, wheat, soy, gluten)
Plain Bagel with Low Fat Cream Cheese
(wheat, soy, gluten, vegetarian, dairy)
I do not want this selection
Breakfast Fruit Selection
(Required)
Apple
(vegan)
Banana
(vegan)
I do not want this selection
Lunch Selections
Lunch Beverage Selection
(Required)
Dasani Bottled Water
Iced Tea
I do not want this selection
Lunch Selections
(Required)
Please select an option below to view your ordering options
Sandwich
Salads & Wraps
I do not want this selection
Lunch Sandwich Selections
(Required)
French Ham & Boursin Cheese Sandwich - Tomato, lettuce, red onion, Dijon mustard, mayonnaise, ciabatta
(dairy, wheat, gluten, high carbon)
Veggie Sandwich on Ciabatta - Cucumber, tomato, grilled zucchini, alfalfa sprouts, arugula, avocado spread
(vegetarian, dairy, wheat, gluten, low carbon)
Korean Steak Sandwich- marinated tri tip, Napa cabbage, shaved carrots, cilantro, kimchi, Korean gochujang aioli, grilled scallions, ciabatta
(dairy, egg, soy, wheat, gluten)
Lunch Salad Selections
(Required)
Taco Bowl without Meat - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, vegetarian, low carbon)
Taco Bowl add Chicken - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, low carbon)
Taco Bowl add Salmon - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, fish, low carbon)
Caesar Salad without Meat
(dairy, wheat, gluten, egg, fish, soy)
Caesar Salad with Chicken
(dairy, wheat, gluten, egg, fish, soy)
Mezza Plate - Hummus, tomato and red onion salad, rice stuffed grape leaves, olives, pita bread -
(dairy, wheat, gluten, low carbon)
Baby Kale, Spinach and Radish Salad add Chicken - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, wheat, gluten, low carbon)
Baby Kale, Spinach and Radish Salad add Salmon - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, fish, wheat, gluten, low carbon)
Lunch Dressing Selection
(Required)
Ranch
(vegetarian, dairy, egg, soy)
Balsamic Vinaigrette
(vegan, low carbon)
Caesar Dressing
(dairy, egg, fish, soy)
Lemon Oregano Vinaigrette
(vegan, low carbon)
Lunch Side Selection
(Required)
BBQ Chips
(vegan, low carbon)
Classic Potato Chips
(vegan, low carbon)
Apple
(vegan)
Banana
(vegan)
I do not want this selection
Lunch Dessert Selection
(Required)
Chocolate Chip Cookie
(vegetarian, milk, egg, wheat, soy, alcohol, tree nuts, peanuts, gluten)
Oatmeal Raisin Cookie
(vegetarian, milk, egg, wheat, tree nuts, peanuts, soy, alcohol, gluten)
Vegan Chocolate Chip
(tree nuts, wheat, soy, alcohol, milk, egg, peanut, gluten, vegan, low carbon)
Vegan Brownie
(vegan, wheat, soy, alcohol, milk, egg, tree nut, peanut, gluten, low carbon)
I do not want this selection
Dinner Selections
Dinner Beverage Selection
(Required)
Dasani Bottled Water
Iced Tea
Minute Maid 100% Apple Juice
Minute Maid 100% Orange Juice
Coca-Cola
Diet Coke
Sprite
I do not want this selection
Dinner Selections
(Required)
Please select an option below to view your ordering options
Hot Entrée
Sandwich
Salads & Wraps
I do not want this selection
Dinner Sandwich Selections
(Required)
French Ham & Boursin Cheese Sandwich - Tomato, lettuce, red onion, Dijon mustard, mayonnaise, ciabatta
(dairy, wheat, gluten, high carbon)
Veggie Sandwich on Ciabatta - Cucumber, tomato, grilled zucchini, alfalfa sprouts, arugula, avocado spread
(vegetarian, dairy, wheat, gluten, low carbon)
Korean Steak Sandwich- marinated tri tip, Napa cabbage, shaved carrots, cilantro, kimchi, Korean gochujang aioli, grilled scallions, ciabatta
(dairy, egg, soy, wheat, gluten)
Dinner Salad Selections
(Required)
Taco Bowl without Meat - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, vegetarian, low carbon)
Taco Bowl add Chicken - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, low carbon)
Taco Bowl add Salmon - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, fish, low carbon)
Caesar Salad without Meat
(dairy, wheat, gluten, egg, fish, soy)
Caesar Salad with Chicken
(dairy, wheat, gluten, egg, fish, soy)
Mezza Plate - Hummus, tomato and red onion salad, rice stuffed grape leaves, olives, pita bread -
(dairy, wheat, gluten, low carbon)
Baby Kale, Spinach and Radish Salad add Chicken - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, wheat, gluten, low carbon)
Baby Kale, Spinach and Radish Salad add Salmon - Romaine, pinto beans, corn, tomato, jalapeno, queso fresco, tortilla chips
(dairy, fish, wheat, gluten, low carbon)
Dinner Dressing Selection
(Required)
Ranch
(vegetarian, dairy, egg, soy)
Balsamic Vinaigrette
(vegan, low carbon)
Caesar Dressing
(dairy, egg, fish, soy)
Lemon Oregano Vinaigrette
(vegan, low carbon)
Dinner Hot Entrée Selections
(Required)
Turkey and Black Bean Chili and Cornbread
(wheat, soy, gluten, high carbon footprint)
Carne Asada Burrito – pinto beans, cheese, salsa, flour tortilla
(wheat, gluten)
Penne Pasta with Pomodoro
(wheat, soy, gluten, dairy)
Penne Pasta with Pomodoro with Vegan Meatballs
(wheat, soy, gluten, dairy)
Pan Seared Salmon – Roasted cauliflower, harissa spice, blistered cherry tomatoes, lime (wheat, soy, gluten, fish, egg)
Dinner Side Selection
(Required)
BBQ Chips
(vegan, low carbon)
Classic Potato Chips
(vegan, low carbon)
Apple
(vegan)
Banana
(vegan)
I do not want this selection
Dinner Dessert Selection
(Required)
Chocolate Chip Cookie
(vegetarian, milk, egg, wheat, soy, alcohol, tree nuts, peanuts, gluten)
Oatmeal Raisin Cookie
(vegetarian, milk, egg, wheat, tree nuts, peanuts, soy, alcohol, gluten)
Vegan Chocolate Chip
(tree nuts, wheat, soy, alcohol, milk, egg, peanut, gluten, vegan, low carbon)
Vegan Brownie
(vegan, wheat, soy, alcohol, milk, egg, tree nut, peanut, gluten, low carbon)
I do not want this selection
Because it after 4pm, you will receive default meals for delivery. To make meal selections for the following day, please make your order between 3am and 4pm. Please submit your order below to receive a confirmation email.
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Default Breakfast
No
Yes
Default Breakfast Beverage Selection
(Required)
Dasani Bottled Water
Default Breakfast Entrée Selections
(Required)
Cheerios with Low Fat Milk
(dairy, low carbon)
Default Breakfast Pastry Selection
(Required)
Plain Bagel with low fat cream cheese
(vegetarian, dairy, wheat, gluten, soy)
Default Breakfast Side Selection
(Required)
Apple
(vegan, low carbon)
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Default Lunch
No
Yes
Default Lunch Beverage Selection
(Required)
Dasani Bottled Water
Default Lunch Entrée Selection
(Required)
Caesar Salad with Chicken
(dairy, wheat, gluten, egg, fish, soy)
Default Lunch Dressing Selection
(Required)
Caesar Dressing
(dairy, egg, fish, soy)
Default Lunch Side Selection
(Required)
Vegan Chocolate Chip Cookie
(soy, tree nuts, wheat, gluten, vegan, low carbon. Made in a facility that also processes dairy, eggs, peanuts, and alcohol.)
This field is hidden when viewing the form
Default Dinner
No
Yes
Default Dinner Beverage Selection
(Required)
Dasani Bottled Water
Default Dinner Entrée Selection
(Required)
Penne Pasta with pomodoro with vegan Meatballs
(wheat, gluten, soy)
Default Dinner Side Selection
(Required)
Classic Potato Chips
(vegan, low carbon footprint)
Default Dinner Dessert Selection
(Required)
Vegan Brownie
(vegan, wheat, soy, alcohol, milk, egg, tree nut, peanut, gluten, low carbon)
