Box Lunch Request Form

Students with OU meal plans may request a box lunch if they have a class schedule or work conflict. To do so, print and complete this form then return it to:

University Housing Office
448 Hamlin Hall
Rochester, MI 48309-4401
 

Name:     Date:
Student Number:
Meal Ticket Number:
Phone Number:

Reason For Request:

Check One:  Breakfast   Lunch   Dinner

Check Day(s):   Monday   Tuesday   Wednesday   Thursday   Friday

How Long:  Dates  
Duration of Semester Dates

________________________________________   __________
 Student's Signature
 		   Date
________________________________________   __________
Assistant Director of Residence Halls
 		   Date
________________________________________   __________
Food Service Manager   Date