Religious Diet Interview

• Legal Form Number: BP-A1142
• Date: 2022-10
• Year: 2022
• Section: Federal Bureau of Prisons

BP-A1142 RELIGIOUS DIET INTERVIEW

OCT 22

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

Name of Inmate: Reg. No.: Date of interview:

1. What are your religious dietary needs?

2. What are the religious reasons for your dietary needs?

3. Why can’t your religious dietary needs be met by self-selecting foods from the mainline and salad/hot bar (where

the salad/hot bar is part of the Food Service Program)?

4. Do you understand that if you are approved, you may only purchase and/or consume foods from the Commissary

which are in compliance with your religious dietary regulations?

These answers accurately reflect my religious dietary needs.

Official Religious Preference

Signature of Inmate: Reg. No.:

Signature of Chaplain: Date of interview:

Religious Diet Accommodation: Self-selected main line;___Kosher ___Halal

Record Copy - Inmate Central File (Section 4); Copy - Chaplaincy File

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