• 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 the 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 annually updated Dietary Request Forms. Best practice would be to annually update the dietary request forms. Dietary Forms on file will remain valid until there is a request to modify or discontinue the request.


    To CHANGE or MODIFY full or partial existing dietary requests, will require submitting another dietary request form and must have both parent/guardian and medical authority signatures for Sections A & B.  Section C only requires a parent/guardian signature. 

    To DISCONTINUE the entire request, another dietary request form must be submitted, but only the parent/guardian signature is required for all Sections (A, B & C).  A medical authority signature is not required to discontinue a dietary request. 


    Forms: