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Meal Plan Accommodation Request Form

Please submit your Meal Accommodation Request Form below. For additional information regarding on-campus services and general nutrition, please visit Dining Services’ website at https://basc1.org/eat/dietary-information/special-dietary-needs

Disability documentation to establish eligibility for a reasonable accommodation is required. Please submit supporting documentation to Hazen Center for Integrated Care Attn: Lynne Maier via fax at (585)-395-2559 or upload to the "My Hazen" student portal located at https://www.brockport.edu/life/health_center/

Documentation should meet all requirements outlined in section 3 of the Meal Plan Accommodation Process (https://basc1.org/eat/dietary-information/special-dietary-needs/20-eat-section/208-meal-plan-accommodation-request).

  • Student Name: Student Name: *
  • Cell Phone: Cell Phone: * - -
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