University of Wisconsin - Stout

Meal Plan Change Request - North 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 - $146.00 Baseline Funds + $572.00 Board Fee = $718.00

Plan 2 - $197.00 Baseline Funds + $572.00 Board Fee = $769.00

Plan 3 - $252.00 Baseline Funds + $572.00 Board Fee = $824.00

Plan 4 - $312.00 Baseline Funds + $572.00 Board Fee = $884.00