Worry Less Pantry Application Worry Less Pantry Application Please fill out the form below and your application will be reviewed. Thank you! Name * Name First Name First Name Last Name Last Name Date * Email * Student ID * Student Year. If you are filling this out over the summer, please indicate what year you will be in the upcoming fall semester. * FreshmanSophomoreJuniorSenior Student Year. If you are filling this out over the summer, please indicate what year you will be in the upcoming fall semester. What is your reason for requesting access? If you have food allergies, please list all food allergies below. * Have you had allergy/celiac testing in the last 5 years? Yes No OtherOther Do you have medical documentation you can submit to the dietitian Yes No pendingpending If you have (a) food allergy(ies), who was it diagnosed by? * MyselfPhysicianOther Is your food allergy or need for this pantry registered with Student Health Services? * YesNoOther Do you have any other dietary preferences, intolerance, restrictions? * VeganVegetarianKosherNoneOther Do you have any other dietary preferences, intolerance, restrictions? Are you a student athlete? * YesNo Additional information that we should be aware of. Submit If you are human, leave this field blank.