DINING PLAN REQUEST FORM

Fill out this form by completing sections 1 through 5. Return it to your Resident Services Office along with any requested documentation for consideration. PLEASE
ALLOW TWO WEEKS FOR YOUR REQUEST TO BE PROCESSED IF ALL DOCUMENTATION IS ALSO SUBMITTED. RESIDENTS ARE REQUIRED TO MAKE SCHEDULED
HOUSING PAYMENTS UNTIL NOTIFIED OF A DECISION. If adding a Dining Plan, see back of form for Terms & Conditions of the Dining Contract.
Full Name: Student ID #:
8 ___
___ 6 ___ ___ ___ ___ ___ ___ ___ 2268253

Your Community: Apartment/Room #:

INFORMATION
RESIDENT

north district
Aberdeen-Inverness Glen Mor Pentland Hills
Bannockburn Village Lothian The Plaza Phone #:
9179458281
Dundee ✔ North District Stonehaven
UCR email:
Falkirk Oban Family Housing Off-Campus [email protected]

Check one of the following that pertain to you and follow the instructions given.
✔ ADD the following dining plan:
To view plans, go to: dining.ucr.edu/dining-plan-options
DINING PLAN

CHANGE my dining plan from ____________________________________ to ______________________________________.

REQUEST

(a) If the plan you are requesting offers more meals/dining dollars than your current plan, then proceed to Resident Signature (Section 5).
(b) If the plan you are requesting offers fewer meals/dining dollars than your current plan, then proceed to Reason for Change Request (Section 3).

RELEASE me from my dining plan

Dining plan releases are only granted in extreme circumstances. Please complete Reason for Change Request (Section 3).

I have a medical reason.

Please begin your request by registering with the Student Disability Resource Center at the following website: sdrc.ucr.edu. Add a brief
description of your need. Any further communication on your request will come from the SDRC staff.
CHANGE REQUEST
REASON FOR

Other: Other reasons generally are not approved. Please provide as much information as possible for your reason. Attach a separate sheet if
necessary.

Purchase Dining Dollars. Dining Dollars increase the flexibility of your Dining Plan by allowing you to purchase snacks, regular meals, late
night meals and guest meals at alternative locations and times. Dining Dollars are available until the last day of
DOLLARS

Dollar Amount Requested:

DINING

the traditional academic year. Dining Dollar balances DO NOT CARRY OVER to the following year and are non-
refundable. Dining Dollars may be purchased in any amount. However, for every $50 you spend you will receive
$ .0 0 Dining Dollars worth $55.00 (a 10% bonus). Spend $100 and receive 115 Dining Dollars (a 15% bonus!)

5 The information above and provided documentation are correct to the best of my knowledge. I UNDERSTAND THAT I AM REQUIRED TO MAKE
SCHEDULED HOUSING PAYMENTS UNTIL NOTIFIED OF A DECISION.
& DATE
SIGN

Resident Signature: Date:

2024-09-20

FOR OFFICE USE ONLY

Approved
ACCOUNT
UPDATE

Declined
AUTHORIZED HOUSING REPRESENTATIVE SIGNATURE DATE
Reason: Effective Blackboard StarRez
Date: Updated: Updated:

WHITE: HOUSING SERVICES YELLOW: RESIDENT 6/2021

Terms & Conditions for UC Riverside Dining Contracts
Residence Halls/Glen Mor room assignments are integrated with a “Dining Plan.”

Dining Plans may be chosen as an optional “add-on” to assignments at other communities during the contract
process or mid-year at your Resident Services Office. The “Dining Plan” as referenced in the Contract shall be
defined as follows: “Dining Plan Selection” and “Monthly Rate”: The monthly rate of the Dining Plan is billed
monthly during the academic year. The cost will be billed to your R’Web account. All payments are due on the 1st
of the month and considered late after the 15th of the month, or the Friday prior to the 15th if the 15th falls on a
Saturday, Sunday or university-recognized holiday.

THERE WILL BE A $30.00 LATE CHARGE FOR ALL PAYMENTS RECEIVED AFTER THE 15TH DAY OF THE APPROPRIATE
MONTH, OR THE FRIDAY PRIOR TO THE 15TH DAY OF THE APPROPRIATE MONTH IF THE 15TH FALLS ON A SATURDAY,
SUNDAY OR UNIVERSITY-RECOGNIZED HOLIDAY, AND FOR SUBSEQUENT MONTHS UNTIL PAYMENTS ARE MADE
CURRENT. Resident may make an appointment to speak with a UCR HDHS representative to discuss any past due
balance, or anticipated past due balance. However, this will not waive the $30.00 Late Fee. Please do not use
inter-campus mail to send payments. If you need a receipt, send a self-addressed envelope with proper postage
to the Main Cashiers Office and a receipt will be sent back to you.

RESIDENT WITH DINING PLAN ONLY: In the event of early departure, Dining Plan charges will be prorated based
on Residential Restaurant operational days. Any verifiable use of meal swipes and/or Dining Dollars beyond the
prorated amount will be billed to the Resident

DINING PLANS
a. A Dining Plan is composed of “Meal Swipes” that can be used to purchase meals in the Glasgow or Lothian
residential restaurants, and “Dining Dollars” that can be used to purchase personal or guest meals and
snacks at any Residential Restaurant, convenience store, or other dining venue on campus. The selected
Dining Plan may be supplemented with additional value at any time at any Resident Services Office. Note:
During holidays and Quarter breaks, no meals are served at Residential Restaurants and campus food
service and convenience store availability is extremely limited or may be entirely unavailable.

b. The Dining Plan selected at contract signing is for the entire regular academic year (i.e. Fall, Winter and
Spring quarters). Changes are permitted during the first two weeks following the Start of Instruction (as
published by the University) in the Resident’s initial move-in quarter (i.e. Fall, Winter or Spring quarter).
Dining Plan change requests for emergency/exceptional situations submitted with supporting documentation
may be considered after the first two weeks. A class schedule conflict is not a viable reason for a dining
plan change after the first two weeks of the academic year. Dining Plan Change Request forms can be
obtained from and submitted to the Resident Services Office (RSO).

c. “Meal Swipes” are available for use beginning at the next scheduled Residential Restaurant meal following
move-in. Dining Dollars are available for use beginning on Campus Apartment Check-In Day, or the
Effective Date of this Contract for move-ins after Campus Apartment Check-In Day, and may be utilized
through June 30 of the academic year in which Resident is assigned, or the Resident’s move-out if prior to
June 30, after which time they will expire.

d. If Resident’s chosen Dining Plan includes Residential Restaurant meals/”meal swipes,” they are re-set
each quarter. Unused meals do NOT roll over to the next quarter and are NOT refundable. Unused Dining
Dollars DO roll over to the next quarter during the regular academic year, but DO NOT carry over beyond June
30th or beyond the Residents move-out date, whichever comes first, and are NOT refundable.