Revised 7/2020
Meal Plan Only Request
Name: _______ ID#:
(Please Print)
Address:
Cell Phone Number: Email Address:
All students have the opportunity to purchase a meal plan for the semester. This is a convenient option for
students on the go. The cost of a meal plan may be paid with financial aid dependent upon each student’s
financial aid package. Please note the meal plan dollars carry over week to week or to the following semester.
Another option would be to put money on your ID card and replenish it as needed.
If you would like to purchase a meal plan, please complete this form and return it to Business Services to the
following address:
Business Services
MSU-Northern
P.O. Box 7751
Havre, MT 59501
You can also drop it off in the Business Service Office, Cowan Hall 207.
Please select one of the following dollar amounts to be placed on our account for meals. Meal plans must be
purchased for the entire semester.
Meal Plan A $1,280.00 per semester
Meal Plan B $1,820.00 per semester
Meal Plan C $2,240.00 per semester
One time amount to be used throughout the semester $ .
_________________________________________________ ___________________________________
Student Signature Date
