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Self Disclosure Dietary Needs Form
EKU students or guests with food allergies or dietary needs
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* Indicates required question
Please select one of the following:
*
EKU Student
EKU Guest
Name
*
Your answer
Email
*
Your answer
Phone number
Your answer
Would you like to be contacted about this dietary need?:
*
Yes
No
Preferred Method of Contact:
*
Email
Phone Call
Text
Please explain your dietary needs (food allergies, food preferences, restrictions, etc.):
*
Your answer
Semester and year dietary needs begin (if current or future EKU student):
*
Your answer
Additional comments or requests:
Your answer
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