Special Dietary Modification Requests
To better serve our students with special dietary needs who require meal accommodations, please submit a medical statement to your school nurse using this Food and Child Nutrition Services Dietary Request Form.
A signature from both parent/guardian and a medical authority is required for sections A & B of the form or any combination of A & B with Section C. If the section of the form being filled out is only Section C, only a parent/guardian signature is needed and no medical authority signature is required.
Current USDA regulations no longer require annual updated medical statements from a medical authority. Therefore, any forms submitted will be valid until there is a request to modify or discontinue the request.
To CHANGE or MODIFY full or partial Existing Requests, it will require submitting another dietary request form and must have a signature from both parent/guardian and medical authority for Sections A & B. Section C only requires a parent signature.
To DISCONTINUE the Entire Request, it will require submitting another form but only a parent/guardian signature is needed for all Sections (A, B & C). A medical authority signature is not required to discontinue a request.