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Child Nutrition » Special Diet Meal Request / Solicitud para Comidad de Dieta Especial

Special Diet Meal Request / Solicitud para Comidad de Dieta Especial

Meal Accommodation Information
(Schools in NSLP, Breakfast, Snack, and Seamless Summer Programs)
 
Forms:
 
#1 - Medical Accommodation Form
Required if a student needs a modification from the standard meals served. Examples are: dairy free, egg free, gluten free, soy free, vegan, etc. This also pertains to any other allergens we need to be aware of. This form is used if the student requires a different milk substitute other than lactaid or soy milk i.e. almond milk, or oat milk. This form must be signed by a licensed physician, a physician assistant or nurse practitioner.
 
Medical statements should:

                    ● Describe the physical or mental impairment sufficiently in order for the SFA to understand how it restricts a child’s diet
                    ● Explain what must be done to accommodate a child’s disability
                    ● Identify food or foods to be omitted from a child’s diet
                    ● Recommend food or choice of foods that must be substituted in a child’s meals
 
* We reserve the right to ask for clarity on medical accommodation forms if not all information is present.
 
#2 - Parental Request for Substitute Milk
Used when a parent needs their child to have soy milk instead of cow's milk. Not used for them to request oat or almond milk. They need a medical accommodation form for that- see above. A parent or guardian will sign this form. No form is needed if the student requires lactose free milk/lactaid.

CA Dept. ED. - Disability Modifications Including Food Allergies:
https://www.cde.ca.gov/ls/nu/sn/modaccomdisinclfoodalgry.asp
Milk Requirements in Child Nutrition Programs:
https://www.cde.ca.gov/ls/nu/he/milkrequirementsincnps.asp

CNS Civil Rights

 

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: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, 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:

  1. mail:
    U.S. Department of Agriculture
    Office of the Assistant Secretary for Civil Rights
    1400 Independence Avenue, SW
    Washington, D.C. 20250-9410; or
  2. fax:
    (833) 256-1665 or (202) 690-7442; or
  3. email:
    [email protected]

This institution is an equal opportunity provider.