Meal Plan Accommodations Request Form
Today's Date:
Student's Name
Student's ID#
Disclosure of:
Allergies
Medical Condition
Dietary Need(s)
Other
Date of Diagnosis:
Please provide personal statement as to why you are seeking meal plan accommodations.
Please upload supporting medical documentation, or fax documentation to the Director of Health Services at (508) 565-1510.
Please submit your Meal Accommodations Request Form below. This is a confidential form that will be viewed only by the Director of Health Services. For additional information regarding on-campus dietician services and general nutrition, please visit Dining Services’ website at http://www.stonehilldining.com/locations.html.
Submit Form
Should be Empty: