Special Diets and Allergies

1. Print the Medical Statement to Request Special Meals and/or Accommodations form. 

Medical Statement to Request Special Meals and/or Accommodations 

Certificado Médico Para Solicitar Comidas Especiales Y / O Adaptaciones

Declaração Médica Para Solicitação De Refeições Especiais E/Ou Adaptações

Deklarasyon Medikal Pou Mande Manje Espesyal Ak/Oswa Adaptasyon 

• A printed copy of this form is provided with the start of school paperwork and/or may also be obtained from the school nurse.

1. Parent/Guardian must return the completed and signed form back to the school nurse and/or Food and Nutrition Services (FNS) Manager.
   • A signature from the parent/guardian is required for ALL requests.
   • If a student has an intolerance and/or is requesting a food restriction due to religious beliefs, then only the completion of Part 1 is needed. The form will expire one year from the date the parent/guardian signed Part 1.
   • If a student has a food allergy or medical disability, then all parts of the form require completion. Only a licensed medical professional can complete Parts 2 and 3. The form expires one year from the date the licensed medical professional signed Part 3.
2. School nurses will give the completed form to the FNS Manager who will share it with the Special Diets Registered Dietitian (RD) by email FNS Special Diets.
3. Should there be any questions/adjustments needed with meal accommodations, the RD will phone the parent/guardian using the contact information provided on the form.
4. Parent/Guardians should temporarily provide the student with meals from home while the special dietary request is being processed for food accommodation and/or equipment needs.
5. An approval or denial will be communicated to the FNS Manager and/or parent/guardian.

Download to print Procedures for Requesting Special Meals and/or Accommodations English,  Spanish,  Portuguese,  Kreyol .

Special meal requests can be changed/modified or discontinued before the one-year expiration date. To CHANGE/MODIFY or DISCONTINUE a special meal request, a new “Medical Statement to Request Special Meals and/or Accommodations” Form must be signed and submitted.

The Food Allergen Labeling and Consumer Protection Act (FALCPA), which was passed by the US Congress in 2004, identified eight major food allergens that are responsible for 90% or more of serious adverse food-induced reactions in the U.S. In 2021 it was updated to nine major food allergens. Under FALCPA, products must clearly list food allergens on the label.

The FDA exempts highly refined food oils such as soy, corn, fish, peanut, coconut, and sesame from the food label where virtually all the food protein that causes the allergic reaction is removed during processing.