Allergy/Dietary Requirement Self Declaration Form Full Name (First Name & Last Name)* Campus Email* Phone*Residence Hall*If not known, please indicate TBD. Which academic year are you declaring for?* 2022-23 2023-24 Do you have a food allergy?Check all that apply Eggs Fish Milk Peanuts Shellfish Soy Tree Nuts Wheat/Gluten Allergy Wheat/Gluten Celiac Disease Sesame Other Please specify your food allergy.*Do you have a Food Intolerance?Check all that apply Eggs Fish Milk Peanuts Shellfish Soy Tree Nuts Wheat/Gluten Sesame Other Please specify your food intolerance.*Religious Dietary RequirementCheck all that apply Halal Kosher Other Please specify your religious dietary requirement.*Dietary PreferenceCheck all that apply Vegan Vegetarian PhoneThis field is for validation purposes and should be left unchanged.