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Special Diet Meals

This form is for students who have been approved through Disability Services for special accommodations for meals.

Please complete the below information to order your special diet meal.

All meals need to be ordered no later than midnight the day before you’d like your meal. If you do not pick up your meal, you will be charged a meal swipe for that given meal period.

If you have any questions, please contact Karen Hensley at or 804-289-8521.

First Name:  
Last Name:  
Date of Meal:  
Meal Period:  
Estimated time of pick-up:  
Cell phone or best way
to contact you:
Have you been approved by the dietitian to use this form: Yes No  
Please select from the following for your meal:  
Food Allergies