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Meal Request Form

We are sorry you are not feeling well. While initially you may not want to eat, food and liquids can help in your recovery. Please provide us with the following information so that we can assist you:

* Name
Do you have a meal plan?
Student ID number:
Residence Hall:
Room # or temporary location:
Cell Phone:
Email:

Please answer a couple of questions so that we can better help with your nutrition needs:

Do you have access to a:

Refrigerator: Yes No
Freezer: Yes No
Microwave: Yes No
Do you have any food restrictions or food allergies? (If yes explain below) Yes No
Select one:

Flu bag breakfast (bottled water, powerade, whole fruit, oatmeal packet, apple sauce cup, Lipton tea bags, apple and orange juice)

Flu bag lunch or dinner (bottled water, powerade, whole fruit, canned chicken noodle soup, jello, saltine crackers, Lipton tea bags, apple and orange juice)

Hot lunch from Bruce's

Hot lunch from Grains and Greens

Hot dinner from Bruce's

Hot dinner from Grains and Greens

See HDC's menu

If you are ordering dinner, would you like a continental breakfast included? Yes No

Date of pickup:
Time of pickup:
Name of person picking up meals:
Phone:

Your meal card must be presented to the cashier. All alternate meals ordered due to illness will be deducted from your meal plan.

To speak to a manager, please call (804) 289-8522.

If you are submitting your request after 5pm or on a weekend, please call (804)289-8522 and speak to a manager to ensure your request was received.