Food Allergy/ Meal Plan Modification Request

**Please read the below statement before submitting this request**

By submitting this request you are giving permission to the appropriate campus staff to disclose information to necessary parties on a need to know basis (Residence Life Staff, potential/actual roommates, Dining Services). You also understand that this information will be shared with the intent of determining a reasonable meal plan accommodation. You may be required to submit further documentation upon contact by appropriate campus staff. 

Example (ABC123)
Please select all that apply