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Special Dietary Needs

Special Dietary Needs

If your child requires special dietary meal accommodations from the cafeteria, please read the following to determine which form is required to be submitted: 
 

Special Dietary Needs (Allergies, Intolerances, Modified Textures):  A Medical Statement to Request Special Meals and/or Accommodations form must be submitted. The form must be filled out in English and signed by a U.S. licensed physician, physician’s assistant, or nurse practitioner. 
 

Lactose Intolerance (Fluid Milk Only):  Milk is offered during breakfast and lunch as an optional beverage that students are not required to take. If your child has an intolerance to fluid cow’s milk and no other food allergies and you would like soy milk or Lactaid to be offered in place of regular milk due to dietary needs, please submit a Parental Request for a Fluid Milk Substitution form.
 

Please submit forms to the student’s school health clerk.

pdfMedical Statement to Request Special Meals (CNP 925 Rev. 03/23)
pdfParental Request Form for Fluid Milk Substitute (SNP 26 Rev. 12/22)

USDA NONDISCRIMINATION STATEMENT

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at 202-720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at 800-877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: complaint form, from any USDA office, by calling 866-632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:


 
mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
fax:
833-256-1665 or 202-690-7442; or
email:
program.intake@usda.gov

 
This institution is an equal opportunity provider.