This form is currently under maintenance. While form maintenance is occurring, please email the following to Patrick Brinyark, briny001@ua.edu, from your Crimson email.
Name:
CWID:
Reason for Exemption Request:
- UA Full-Time Faculty/Staff
- Military Veteran (A copy of your DD214 must be attached.)
- Head-of-Household (Head of Household is defined as an individual who actually supports and maintains in one household one or more individuals who are closely connected with them by blood relationship, relationship by marriage, or by adoption, and whose right to exercise family control and provide for the dependent individuals is based upon some moral or legal obligation. A copy of a tax form, birth certificate of the dependent, or court document showing custody of a child MUST be attached.)
- Married (A copy of your marriage certificate MUST be attached.)
- Dietary Circumstance (Fully and concisely describe your dietary circumstances. Attach supporting documentation from a qualified professional, a person who is licensed or otherwise properly credentialed and possesses expertise in the area for which exemption is sought.)
- Other (Fully and concisely describe your personal circumstances. Being a member of a fraternity or sorority, living off-campus, or living at home are not valid reasons for exemption.)