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Student Name
KU E-mail Address (use personal email if you are a perspective student)
Which dorm will you be living in? (Leave blank if unknown)
Food Allergy to: (check all that apply)
Dairy
Egg
Fish
Peanut
Shellfish
Soy
Tree nut
Wheat
Sesame
Other:
Do you have a gluten intolderance?
Yes
No
Do you follow any of the dietary preferences listed below?
Halal
Kosher
Vegan/Vegetarian
Have you completed the application through the KU Student Access Center?
Yes
No
Would you like to receive our monthly nutrition e-newsletter?
Yes, sign me up!
No, thank you.
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