SOP 409.04.28-att-1: Offender Alternative Entrée Program Packaged Meal Participation Form

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||Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.
SOP 409.04.28
Attachment 1
12/11/24
Offender Alternative Entrée Program Packaged Meal
Participation Form

The Alternative Entrée Meal Program is available to all offenders free of charge. You are
required to sign up in advance if you would like to participate in the Alternative Entrée Meal
Program.This is the OFFICAL SIGN-UP FORM to PARTICIPATE. If you choose to
participate in the Alternative Entrée Program and are observed or caught trying to pick-up a
regular tray you can receive disciplinary action and/or be removed from the program. Once your
sign-up for the Alternative Entrée Program we expect you to follow the instructions given by
your institution. If you decide that you no longer want to participate in the Alternative Entrée
Meal Program, you will need to complete the Offender Alternative Entrée Program Packed Meal
Removal Form.

If you would like further information about the Alternative Entrée Program, please review
SOP 409.04.28.

Alternative Entree Meal Options are not available at all sites; therefore, you may have to
be transferred:

PRE-PACKAGED AEP VEGAN MEAL PLAN ______________
Animal Product Free (no eggs, dairy, or meat). Kosher vegan foods will be used in this Meal Program
Halal certified food will be utilized when available.


Please complete in detail the second page of this document. Once completed please submit request to
your facility’s designee. Then the request will be submitted for the approval process. If approved, you
will be notified, and the meal plan process explained. Participation in the program may not occur until the
approval process is completed.


Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________








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||Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________|Retention Schedule: Upon completion, this form shall be kept in a local filing area in Food Service for one (1) year
in an active file and shall be kept five (5) years in an inactive file, then destroyed; a copy will placed in the
offender’s institutional file.


409.04.28
Attachment 1
10/13/24

Offender Alternative Entrée Packaged Meal Program
Participation Form Addendum

Please answer the following questions with as much detail as possible. If additional space is needed,
please use the backside and/or attach additional sheets. This form must be attached to the Official
Alternative Entrée Program Packaged Meal Participation Form if you wish to be considered for the
Program. Please attach any additional supporting information. This information will be reviewed within
two (2) business days. The offender will be notified after the participation form has been reviewed and
approved or denied.If you would like further information about the Alternative Entrée Program,
please review SOP 409.04.28.


1. Religious Affiliation: ___________________________________________________

2. Years Practicing Religion: ______________________________

3. List your Religious Dietary Beliefs/Restrictions:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4. Please explain why the Georgia Department of Corrections Regular Meal Program does not
meet the requirements of Religious Dietary Beliefs/Restrictions?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. Please attached and/or note any references such as books, web sites, etc. that would support/
document your statements.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Offender Name: ___________________________________ GDC#: __________________

Date Request Completed: _________________________

Date Request Received: ___________________________

Signature of Receipt: ______________________________________ (Facility Designee)

Print Name/Title: ______________________________________________

Request Approved or Denied: ________________________||
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