Meal Plan Accommodation Request Form

Meal Plan Accommodation Request Form

Please be sure to thoroughly review all Meal Plan Accommodations Procedures and Guidelines before submitting this form. An appointment with Kim Pierce, RD, LDN is required before pursuing a meal plan accommodation.
Today's Date

MonthDayYear
Student's Name
Student's ID#
Class Year
Residence Hall
Date of required meeting with Kim Pierce, Stonehill's Dietician

MonthDayYear
Date
Have you previously been approved for a meal plan accommodation?
Please provide detailed information about your disability and your dining accommodation needs.
Are you currently being treated by a specialist for this condition?
When did your symptoms first begin?
Do you follow a medically prescribed diet?
What foods can you eat?
Which foods must your avoid or limit?
If approved, how will you adequately meet your dietary needs?
You may upload supporting medical documentation, email to oar@stonehill.edu or fax to OAR at (508) 565-1492.

Upload a File

Cancelof
Please submit your Meal Accommodation Request Form below. For additional information regarding on-campus services and general nutrition, please visit Dining Services’ website at https://stonehill.sodexomyway.com/
Should be Empty: