Allergy | UMD Dining Services

Allergies and Dietary Requirement Form

Name (If Submitting on Behalf of Someone Else)

Student Name

Student UMD ID #

Student Phone #

Best Time to Call

Student Email

Where Do/Will You Live on Campus?

Specific Food Allergy or Dietary Requirement

Do you use an Epi Pen?

Doctors Note

One file only.
100 MB limit.
Allowed types: jpg, png, pdf.

If you have any questions or concerns, please contact Sister Maureen Schrimpe (IHM) via email at schrimpe@umd.edu or via telephone at 301-314-8058.