Food Allergy Accommodation Request
Submit your request for special accommodations related to food allergies. Please provide accurate and complete information to help us support your needs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your role or affiliation?
*
Please Select
Student
Employee
Visitor/Guest
Other
Location or Event Where Accommodation is Needed
*
Please specify your food allergy/allergies.
*
Peanuts
Tree nuts
Milk/Dairy
Eggs
Fish
Shellfish
Wheat/Gluten
Soy
Other
Please describe the severity of your allergy.
*
Mild (discomfort, mild symptoms)
Moderate (requires medication, but not life-threatening)
Severe (anaphylaxis or life-threatening reaction)
Describe symptoms experienced during an allergic reaction.
*
Please specify the type of accommodation you are requesting.
*
Special meal preparation
Ingredient substitution
Avoidance of cross-contact
Labeling of food items
Other
Please upload documentation (e.g., doctor's note, medical records) if available.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional information or special instructions
Submit Request
Should be Empty: