Does your child have special nutritional needs? Our Menu Planner and Registered Dietitian, Eric Estrada, will be happy to work with you to ensure that nutritional and other special meal accommodations as recommended or prescribed by a medical authority are made to your child’s school meals. Please complete the Special Diet Form or Milk Substitute Statement and submit to the Food and Nutrition Services Department to get the process started. If we need further clarification or instructions, we may contact you. Please return the completed Special Diet Request form to email@example.com.
This form must be used for students who require special diets due to disabilities, and should be updated whenever necessary. A medical doctor or other authorized, recognized medical authority must complete the applicable areas.
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: 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:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
(833) 256-1665 or (202) 690-7442; or
This institution is an equal opportunity provider.12/09/2022