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First-Year Meal Plan Exemption Request Form The University of Alabama Auxiliary Services Dining Services NAME CWID ADDRESS HOME PHONE STREET ADDRESS CITY STATE ZIP CELL PHONE I am requesting exemption from the University of Alabama First-Year Meal Plan Program. The specific qualifying factor is DIETARY CIRCUMSTANCE EXEMPTION. Please attach a letter concisely and fully describing your dietary circumstances. Attach supporting documentation from a licensed Medical Physician. Students who fail or refuse to comply with the First-Year Dining Program and/or who furnish or submit false information to a University official or office in connection with a request for exemption 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. Requests for exemption must be received in the University of Alabama Dining Services Office on or before the following dates based upon you intended first term of enrollment no later than the following schedule - July 15 for Fall Semester - December 1 for Spring Semester For information regarding requests for exemptions please contact the University of Alabama Dining Services Office at 205 348-6816 or 1-888-Bama Food 226-2366 or visit the website at www. Attach supporting documentation from a licensed Medical Physician. Students who fail or refuse to comply with the First-Year Dining Program and/or who furnish or submit false information to a University official or office in connection with a request for exemption 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. Requests for exemption must be received in the University of Alabama Dining Services Office on or before the following dates based upon you intended first term of enrollment no later than the following schedule - July 15 for Fall Semester - December 1 for Spring Semester For information regarding requests for exemptions please contact the University of Alabama Dining Services Office at 205 348-6816 or 1-888-Bama Food 226-2366 or visit the website at www. bamadining. ua.edu. STUDENT SIGNATURE Please return form to For Office Use Only Date Exemption Request Received Initial Decision Approved/Denied Date Initials Date Appeal Received Appeals Committee Decision Upheld/Reversed Date University Dining Services Attn Kristina Hopton-Jones Box 870390 Tuscaloosa AL 35487-0390. First-Year Meal Plan Exemption Request Form The University of Alabama Auxiliary Services Dining Services NAME CWID ADDRESS HOME PHONE STREET ADDRESS CITY STATE ZIP CELL PHONE I am requesting exemption from the University of Alabama First-Year Meal Plan Program* The specific qualifying factor is DIETARY CIRCUMSTANCE EXEMPTION* Please attach a letter concisely and fully describing your dietary circumstances. Attach supporting documentation from a licensed Medical Physician* Students who fail or refuse to comply with the First-Year Dining Program and/or who furnish or submit false information to a University official or office in connection with a request for exemption 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* Requests for exemption must be received in the University of Alabama Dining Services Office on or before the following dates based upon you intended first term of enrollment no later than the following schedule - July 15 for Fall Semester - December 1 for Spring Semester For information regarding requests for exemptions please contact the University of Alabama Dining Services Office at 205 348-6816 or 1-888-Bama Food 226-2366 or visit the website at www.

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