SDE: Forms for School Nutrition Programs

Forms for School Nutrition Programs


School Nutrition Programs   Program Guidance  |  Resources  |  Nutrition Education 



{Elementary students eating lunch}
The list below includes state and federal forms for the U.S. Department of Agriculture (USDA) school nutrition programs, including the School Breakfast Program (SBP), National School Lunch Program (NSLP), Seamless Summer Option (SSO) of the NSLP, Afterschool Snack Program (ASP) and Special Milk Program (SMP). For more information visit the CSDE Web page for each 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


A
  • Action Planning Form  [PDF]   [DOC]
  • 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]
  • 2015-16 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]
    • 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 (Version 1)  [PDF]  [DOC]
    • Parent/Guardian Notification Letter for Direct Certification (Version 2)  [PDF]  [DOC]
    • Foreign Language Translations for Free and Reduced-price Application Forms  (USDA)
  • Authorized Signatures Change Form  [PDF]   Revised April 2015
    • Authorized Signatures Change Form Instructions  [PDF]  Revised April 2015
C
  • Collection Procedures Description  [PDF]
D
  • Daily Milk Count Worksheet  [PDF]   [DOC]  [Excel]
    • Daily Milk Count Worksheet Instructions  [PDF]
  • Disclosure Release Request for Free or Reduced Eligibility Status  [PDF]  [DOC]
E
  • Edit Check Worksheet for Lunch  [Excel]
    • Instructions for Edit Check Worksheet for Lunch  [PDF]  
  • Edit Check Worksheet for Breakfast and Lunch  [Excel]
    • Instructions for Edit Check Worksheet for Breakfast and Lunch  [PDF]
F H I L
  • Lunch Menu Planning Checklists (Five-day Week)
    • Grades K-5  [PDF]
    • Grades 6-8  [PDF]
    • Grades 9-12  [PDF]
    • Grades K-8  [PDF]
    • Grades PK-8  [PDF]
  • Lunch Menu Planning Checklists (Seven-day Week)
    • Grades K-5  [PDF]
    • Grades 6-8  [PDF]
    • Grades 9-12  [PDF]
    • Grades K-8  [PDF]
    • Grades PK-8  [PDF]
M
  • Meal Pattern Exception Request Form for Residential Child Care Institutions (RCCIs)   [DOC]
  • Medical Statement for Children with Disabilities  [PDF]   [DOC]  Revised June 2015
  • Medical Statement for Children without Disabilities  [PDF]   [DOC]  Revised June 2015
N
  • Nonprogram Pricing Worksheet (see "Pricing Worksheet for Adult Meals and A la Carte Sales")
O
  • On-Site School Monitoring Sheet for Multiple Sites  [PDF]  [DOC]
P
  • Paid Lunch Pricing Worksheet for School Year 2014-15  [Excel]
  • Policy Statement  [DOC]
  • Preschool Menu Forms (Five-day Week)
    • Breakfast Ages 1-2  [PDF]  [DOC]
    • Breakfast Ages 3-4  [PDF]  [DOC]
    • Lunch Ages 1-2  [PDF]  [DOC]
    • Lunch Ages 3-4  [PDF]  [DOC]
  • Preschool Menu Forms (Seven-day Week)
    • Breakfast Ages 1-2  [PDF]  [DOC]
    • Breakfast Ages 3-4  [PDF]  [DOC]
    • Lunch Ages 1-2  [PDF]  [DOC]
    • Lunch Ages 3-4  [PDF]  [DOC]
  • Production Records
  • Pricing Worksheet for Adult Meals and A la Carte Sales  [Excel]
  • Public Release  [PDF]  [DOC]
S V W
  • Whole-grain Rich (WGR) Exemption Request Form  [PDF]   [DOC]


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


USDA Nondiscrimination Statement
CSDE Nondiscrimination Statement




Content Last Modified on 6/29/2015 12:46:02 PM