University of Wisconsin - Stout

Meal Plan Change Request - South Campus

ID Number

Name

E-mail address

Hall

Room Number

I wish to CHANGE to the following Meal Plan for second semester - check

Plan 1 - $196.00 Baseline Funds + $637.00 Board Fee = $833.00

Plan 2 - $251.00 Baseline Funds + $637.00 Board Fee = $888.00

Plan 3 - $310.00 Baseline Funds + $637.00 Board Fee = $947.00

Plan 4 - $363.00 Baseline Funds + $637.00 Board Fee = $1,000.00