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Off Campus Summer Dining Plan Form

To sign up for a summer meal plan, please fill in the following form. An e-mail with the following information will be sent to the address you provide and to the Office of Housing and Residence Life for processing. You may also print this form, sign it, and return it to the Housing and Residence Life office. A printable version of the Off Campus Summer Dining Plan form is also available.

Note that only off-campus students should use this form. On-campus students will specify their meal plans on their housing applications.

*Required

Name*

E-mail*

Banner ID*

Phone/cell

Dining Plan and Session(s) Attending*

Early Session, three weeks (May 3–23)
1 week between summer sessions, (May 24–May 30)
Summer I, five weeks (May 31–July 4)
Summer II, five weeks (July 5–August 8)
Other sessions not listed (specify below)

Other times you need housing for summer

Note that meal plans are weekly, Sunday–Saturday.

Start Date
[None]

End Date
[None]

Reason for Irregular Summer Housing

Total amount due = meal plan price multiplied by the number of weeks

Meal Plan*

Meal Plan A: Nineteen meals a week, Sunday through Saturday, $71.20/week, $356 for 5 weeks
Meal Plan B: Fourteen meals a week, Sunday through Saturday, $67.00/week, $335 for 5 weeks
Meal Plan D: Ten meals a week, Sunday through Saturday, $64.20/week, $321 for 5 weeks†
Meal Plan G: Five meals a week, Sunday through Saturday, $36.00/week, $180 for 5 weeks†

†Note: Meal Plan D and G are available only for off-campus students. On-campus students need to choose a dining plan on their housing contract.

Agreement

The Dining Service Agreement is a binding legal agreement between the university and the individual student. Meals provided under this agreement are for the agreement holder only. By submitting this form, you are indicating that you, the contract holder, have read, understand, and accept the terms in this form and any terms specified on the Summer Housing and Dining Page and that you agree to abide by all reasonable rules IUP may issue.

To obtain release from the summer meal plan agreement after signing, or to change meal plans, the student must submit a written request to the Office of Housing and Residence Life no later than 4:00 p.m. on the first day of registered coursework. This request may be sent by e-mail to iup-dining@iup.edu. Requests sent to any other office will not be accepted.

I understand and agree to all terms above

Payment Instructions

To pay using IUP EasyPay, you may either log into URSA or you can find EasyPay at the Bursar’s website.

Upon submission, your browser will be forwarded to Payment Options.

Signature and date (if submitting a paper copy)

_________________________________________________

Office of Housing and Residence Life
Suites on Maple–West, Suite G-37
1099 Maple Street
Indiana, PA 15705-1075
Phone: 724-357-2696
Fax: 724-357-5762
ohrl-assignments@iup.edu
iup-dining@iup.edu
ohrl-maintenance@iup.edu
iup-resnet@iup.edu
iup-ohrl@iup.edu

Office Hours
Monday through Friday
8:00 a.m. – 4:30 p.m.
Summer: 8:00 a.m. - 4:00 p.m.