SAINT LOUIS UNIVERSITY
Apartment/Commuter Meal Plan Exemption Request Form
To Be Completed by Student Making the Request
Change/ Exemption Request Period: Fall 2019
Spring 2020 Academic Year 2019-2020
Year in School (Check One): Freshman Sophomore Junior Senior Graduate
Current Meal Plan: Flex 300 Flex 300 Plus
Best Contact Information Number: (______) ________-_______ SLU Email: ______________________________@slu.edu
Exemption Request Based On (check one): Financial Hardship
1
Off-Campus Internship/Student Teaching
2
(Must be submitted each semester of the
Internship or Student Teaching)
Veteran/Non-Traditional Student
Other
3
(such as religious dietary observations, food allergies, medical conditions)
Reason for Change/Exemption Request in Detail:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
For exemption based on off-campus internship/student teaching, please complete the below session before submitting:
DEPARTMENT APPROVAL: I verify the student making the above request meets the exception guidelines for the requested exemption.
______________________________________________ ____________________________________________________
Signature of Verifying Authority Position Title
______________________________________________ ______________________
_______________
Print Name Phone Number Date
1
In order for the student to be exempt from the plan, the student must have an EFC (Expected Family Contribution) of $500 or less. This will
be verified with Student Financial Services.
2
Off campus student teaching, internship, clinical or cooperative that prohibits the student from coming on campus: these students must be enrolled in such
experience for the entire semester. These students do not reside in the SLU housing nor do they take additional classes on campus during the student
teaching or internship period. Absence should be for the entire semester. In order for this student to be exempt, the student must submit this signed
exemption request by the Dean of the relevant program.
3
Attach physician documentation of allergy diagnosis, medical condition, surgical related modifications required, or gastrointestinal diagnosis and
modifications.
Student Signature Date
Office Use Only
Date Received: ____/_____/_____ Approved Not Approved Approval Signature:_________________________________________________
Effective Date: _____/_____/______ Documentation Attached: Y N
Notification Sent To Student’s SLU Email Account? Y N Date Email Sent:______/______/_______
Name (Last, First, Middle) Request Date (month/day/year)SLU Banner ID #
Flex 600
Please fax or email to Attn: Cards & Parking Services at 314-977-3429 or cardservices@slu.edu with the appropriate documentation, no later than three weeks after the start of
the relevant semester. Forms received after the deadline will not be considered. A new exemption form must be submitted each semester or when there are changes to the
student's financial or internship/coop status. For dietary related exemption requests, email this form to nutrition@slu.edu.
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