School Nutrition Forms

  • How to request a modified diet due to medical reasons (form listed above)

    All requests for special nutritional needs must be submitted on a DPS Medical Statement Form signed by a physician.  Forms are available online (see below), from your cafeteria manager or at the School Nutrition Services Central Office.  Requests must be submitted annually at the beginning of the school year or whenever a change in diet is required.  Once the completed form is received the request will be reviewed by the Registered Dietitian.  Any necessary menu accommodations will be communicated by the Registered Dietitian to the cafeteria manager.  Accommodations are considered for those students requiring a change in diet based on medical need, not for personal preferences. 

    PLEASE NOTE:  National School Lunch Program Regulation 210.10

    Schools must make substitutions in lunches and afterschool snacks for students who are considered to have a disability under 7 CFR part 15b and whose disability restricts their diet.  Schools may also make substitutions for students who do not have a disability but who cannot consume the regular lunch or afterschool snack because of medical or other special dietary needs.  Substitutions must be made on a case by case basis only when supported by a statement of the need for substitutions that includes recommended alternate foods, unless otherwise exempted by Food & Nutrition Services.  Such statement must, in the case of a student with a disability, be signed by a physician or, in the case of a student who is not disables, by a recognized medical authority.