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, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights,

1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410;

(2) fax: (202) 690-7442; or

(3) email: [email protected].

This institution is an equal opportunity provider.