New Food Request Form: Nutrition Coordinating Center: University of Minnesota

New Food Request Form

Fields marked with an asterisk (*) are required.

Client Name*
Client Number*
Institution
Email*	Resolution returned to this address.
Phone Number
NDSR Version*	(New Version)
New Food Name*
Web Page
Amount Consumed
Serving Size	from label
Weight per Serving	from label
Calories	kcal
Fat	g
Saturated Fat	g
Trans Fat	g
Cholesterol	mg
Sodium	mg
Potassium	mg
Carbohydrate	g
Dietary Fiber	g
Sugars	g
Protein	g
Ingredients
Vitamin A	%DV IU
Vitamin C	%DV mg
Calcium	%DV mg
Iron	%DV mg
Vitamin D	%DV mcg
Vitamin E	%DV mg
Vitamin K	%DV mcg
Thiamin	%DV mg
Riboflavin	%DV mg
Niacin	%DV mg
Vitamin B6	%DV mg
Folic Acid	%DV mcg
Vitamin B12	%DV mcg
Pantothenic Acid	%DV mg
Phosphorus	%DV mg
Magnesium	%DV mg
Zinc	%DV mg
Selenium	%DV mcg
Manganese	%DV mg
Copper	%DV mg
Other Information

Products