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Special Dietary Accommodation

St. Norbert College follows the guidance of the Americans with Disabilities Act guidelines concerning residential college dining. Students who require a medical special dietary accommodation, please review the special dietary meal plan accommodation procedure and complete the form below.

Personal Information
*Date:
*First name:
*Last name:
*Student ID number:
*Email address:
*Cell phone number:
*Permanent phone number:
*Permanent address:
*City:
*State:
*ZIP code:
*Campus address:
*Class standing: Freshman Sophomore Junior Senior
Are you currently receiving housing accommodation? Yes No
Disability Information
*Please specify your disability (i.e. Crohns, celiac disease, allergies) and describe how it affects you:
*Please list the specific special dietary accommodations you are requesting and how the accommodations will provide greater access to campus dining:
  I have read the Special Dietary Meal Plan Accommodation Procedure (please check).
  I give my consent to Academic Support Services to consult with Dining Services.
  I am aware that I am assuming a reasonable risk eating at any of the college’s eating establishments.