Special Diet Accommodation Form

Students who fail or refuse to comply with the Residential On-Campus Meal Plan Program and/or who furnish or submit false information to a University official or office in connection with a request for accommodation are subject to disciplinary action in accordance with the Student Code of Conduct and to sanctions which could include imposition of a fine and suspension from the University of Alabama.
Last Name *
First Name *
Preferred Name *
CWID *
Cell Phone *
Crimson Email *
Allergies or impairment for which an accommodation is being requested: *
Food items student must avoid: *
Requested Accommodations:
Specify accommodations being requested, if known. The accommodation process is an interactive, individualized process and you will be contact to discuss your specific accommodations.
Attach Supporting Documentation Attach written documentation completed by an appropriate health care provider regarding the disability or disabilities, including but not limited to diagnosis, specific food allergies, and dietary needs. Health care provider must be a person who is licensed or otherwise properly credentialed, possesses expertise in the area for which accommodation is requested, and currently treating the student for the condition for which the accommodation is requested.