Food Allergies & Special Dietary Needs Form
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Student First Name:
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Student Last Name:
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Student CMU ID Number:
Please Note: If you are not currently enrolled at CMU, please indicate in the Student CMU ID Number box above your potential month and year of enrollment at CMU.
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Campus Residence Hall:
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Room Phone:
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Cell Phone:
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CMU Email Address:
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Residential Restaurant:
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Meal Plan:
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Allergy:
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Severity:
Other information we should know about your allergy or dietary concern:
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List Common food choices you eat for Breakfast:
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List Common food choices you eat for Lunch:
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List Common Food choice you eat for Dinner:
Other food choices you commonly eat: