SDE: Forms for School Nutrition Programs

Forms for School Nutrition Programs

School Nutrition Programs   Program Guidance  |  Resources  |  Nutrition Education 

The list below includes forms for the School Breakfast Program, National School Lunch Program, Afterschool Snack Program, Seamless Summer Food Program and Special Milk Program.

A |  B |  C |  D |  E |  F |  G |  H |  I |  J |  K |  L |  M

N |  O |  P |  Q |  R |  S |  T |  U |  V |  W |  X |  Y |  Z

  • Adult Meals and A La Carte Pricing Worksheet (see "Pricing Worksheet for Adult Meals and A la Carte Sales")
  • Afterschool Snack Program Application Addendum  [PDF]  Tab & Type  [DOC]
    • Afterschool Snack Program Application Addendum Instructions  [PDF]
  • Afterschool Snack Daily Count Worksheet (Area Eligible)  [PDF]  [Excel]
  • Afterschool Snack Daily Count Worksheet (Income Eligible)  [PDF]  [Excel]
  • Afterschool Snack Program Menu Form 1 (ages 3-5)  [PDF]   [DOC]
  • Afterschool Snack Program Menu Form 2 (ages 6-18)  [PDF]   [DOC]
  • Afterschool Snack Program On-Site Monitoring Form  [PDF]
  • Annual Revenue and Cost Expenditure Report Form  [PDF]   [DOC]
    • Instructions for Completing Annual Revenue and Cost Report Form  [PDF]
  • 2014-15 Free and Reduced Application Forms
    • Application for Free, Reduced Price Meals or Free Milk: Family  [PDF]   [DOC]
    • Addendum A: Sharing Information with Other Programs   [PDF]   [DOC]
    • Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY)  [PDF]   [DOC]
    • Addendum C: Information on the Supplemental Nutrition Assistance Program  [PDF]
    • Parent/Guardian Letter to Households for Meals and Snacks  [PDF]  [DOC]
    • Parent/Guardian Letter to Households for Special Milk Program  [PDF]  [DOC]
    • Parent/Guardian Notification Letter  [PDF]  [DOC]
    • Parent/Guardian Notification Letter for Direct Certification  [PDF]  [DOC]
    • USDA Foreign Language Translations for Free/Reduced Price Application Forms
  • Authorized Signatures Change Form  [PDF]   Revised April 2015
    • Authorized Signatures Change Form Instructions  [PDF]   Revised April 2015
  • Collection Procedures Description  [PDF]  [DOC]
  • Daily Milk Count Worksheet  [PDF]   [DOC]  [Excel]
    • Daily Milk Count Worksheet Instructions  [PDF]
  • Disclosure Release Request for Free or Reduced Eligibility Status  [PDF]  [DOC]
  • Income Eligibility Guidelines  [PDF]
  • Interschool Agreement Full-Service  [PDF]  [DOC]
  • Interschool Agreement Recipient Site Vended Form  [PDF]  [DOC]
  • Nonprogram Pricing Worksheet (see "Pricing Worksheet for Adult Meals and A la Carte Sales")
  • On-Site School Monitoring Sheet for Multiple Sites  [PDF]  [DOC]
  • Paid Lunch Pricing Worksheet School Year 2014-15   [Excel]
  • Policy Statement  [DOC]
  • Production Records
  • Pricing Worksheet for Adult Meals and A la Carte Sales  [Excel]   New February 2015
  • Public Release  [PDF]   [DOC]

CSDE School Nutrition Programs Staff
Connecticut State Department of Education
Bureau of Health, Nutrition, Family Services and Adult Education
25 Industrial Park Road, Middletown, CT 06457
Telephone: 860-807-2050
Fax: 860-807-2127

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal and, where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.

Content Last Modified on 4/29/2015 1:22:32 PM