Allergy/Dietary Requirement Self Declaration Form Full Name (First Name & Last Name)*Campus Email* Phone*Campus ID#*Residence Hall*Food Allergy or Special Dietary RequirementCheck all that Apply Eggs Fish Milk Peanuts Shellfish Soy Tree Nuts Wheat/Gluten Other Please specify what allergy or dietary requirement.*Religious Dietary Requirement Halal Kosher Other Please specify your religious/dietary requirement.*PhoneThis field is for validation purposes and should be left unchanged.