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* 1. Student Name

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* 2. UIN #

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* 3. Building:

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* 4. Room #:

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* 5. Start date of quarantine:

Date

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* 6. End date  of quarantine:

Date

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* 7. Meal Selection/Type (Each meal costs $8):

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* 8. Please add any dietary restrictions in the section below:

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* 9. Please indicate which category best describes you:

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* 10. If you are an athlete, please indicate which team you are in:

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