Nutrition Assignment Template:

Please complete all areas after you read the Assignment Instructions and upload to
the Assignment Box 3 when you finish.

1. Calories: (Use the amount from your Physical Assessment done with the class)

2. Protein Grams:

3. Carbohydrates Grams:

4. Fiber Grams:

5. Sugar grams:

6. Total Fat grams:

7. Monounsaturated Grams:

8. Polyunsaturated Grams:

9. Saturated Fat Grams:

10. Trans Fat Grams:

11. Cholesterol (mg):

12. Sodium (mg):

13. Potassium (mg):

14. Iron % RDA:

15. Calcium % RDA:

16. Vitamin A % RDA:

17. Vitamin C % RDA: