Meal Plan Waiver

First and Last Name *

Address *

City *

State *

Zip Code *

Class Standing *

1st year
Sophomore
Junior
Senior

Gender

Male
Female
Prefer not to disclose

Current Meal Plan *

19 Meal block
15 Meal block
10 Meal block

Lourdes University requires all students living on campus to have a meal plan. Please provide detailed information for the reason(s) that you are applying for a meal plan exemption. Please have your health care provider fill out the documentation form. Once the request has been received it will be reviewed within seven business days. Thank you. *

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