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 (ASP)
    • ASP Eligibility Checklist  [PDF]  [DOC]
    • ASP Daily Snack Count Record (Site/Area Eligible)  [PDF]  [DOC]
    • ASP Daily Snack Count and Production Record (Site/Area Eligible)  [PDF]  [DOC]
    • ASP Daily Attendance and Snack Count Record (Not Site/Area Eligible)  [PDF]  [DOC]
    • ASP Monthly Attendance and Snack Count Record (Site/Area Eligible)  [PDF]  [DOC]
    • ASP Monthly Attendance and Snack Count Record (Not Site/Area Eligible)  [PDF]  [DOC]
    • ASP Production Record  [PDF]  [DOC]
      • Sample Completed ASP Production Record  [PDF]
    • ASP Menu Form for Ages 3-5  [PDF]  [DOC]
    • ASP Menu Form for Ages 6-18  [PDF]  [DOC]
    • ASP Monitoring Form  [PDF]
  • Application Forms for Free and Reduced (School Year 2016-17)
    • Application for Free and Reduced-price School Meals or Free Milk  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Addendum A: Sharing Information with Other Programs  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY)  [PDF]   Spanish  [PDF]
    • Addendum C: Information on the Supplemental Nutrition Assistance  [PDF]
    • Sample Parent/Guardian Letter: Frequently Asked Questions (FAQs) About Free and Reduced-price School Meals  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Sample Parent/Guardian Letter: Frequently Asked Questions (FAQs) About Free School Milk   [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Parent/Guardian Notification Letter  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Parent/Guardian Notification Letter for Direct Certification (Version 1)  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Parent/Guardian Notification Letter for Direct Certification (Version 2)  [PDF]  [DOC]   Spanish  [PDF]  [DOC]
    • Foreign Language Translations for Free and Reduced-price Application Forms  (USDA)
    • SNAP/TFA Case Number Guidance  [PDF]

  • Annual Revenue and Cost Expenditure Report (see Financial Report)
  • Authorized Signatures Change Form  [PDF]
    • Authorized Signatures Change Form Instructions  [PDF]
C
  • Community Eligibility Provision (CEP)
    • CEP Edit Check Worksheet  [DOC]
      • CEP Edit Check Worksheet Instructions  [PDF]
    • CEP Participation Worksheet  [Excel]
    • CEP Policy Statement Addendum Sample Form  [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 Counting and Claiming (see "Money Collection and Point-of-Service (Meal Count) Systems"
  • Meal Pattern Exception Request Form for Residential Child Care Institutions (RCCIs)  [DOC]
  • Medical Statement for Children with Disabilities  [PDF]  [DOC]
  • Medical Statement for Children without Disabilities  [PDF]  [DOC]
  • Money Collection and Point-of-Service (Meal Count) Systems
    • Overview of Meal Counting and Claiming Process  [PDF]  New July 2016
    • Site Information on Money Collection and POS Meal Count Systems Form  [PDF]  [DOC]
      New July 2016
    • Meal Application and Data Management Process Form  [PDF]  [DOC]  New July 2016
  • Monitoring Checklist (see "On-site School Review Checklist")
N
  • Nonprogram Pricing Worksheet (see "Pricing Worksheet for Adult Meals and A la Carte Sales")
O
  • On-site School Review Checklist for the NSLP  [PDF]  [DOC]  New October 2016
  • On-site School Review Checklist for the SBP  [PDF]  [DOC]  New October 2016
P
  • Paid Lunch Equity Calculations and Tool (USDA)
  • Policy Statement for Free and Reduced-price Meals  [PDF]  [DOC]  Revised July 2016
  • 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 Media Release  [PDF]  [DOC]
S
  • Summer Meals
    • Seamless Summer Option (SSO) Meal Counts
      • SSO Daily Meal Count  [PDF]
      • SSO Weekly Meal Count Consolidation  [PDF]
    • SSO Sample Press Release  [PDF]  [DOC]
    • SSO Sample Sponsor Pre-operational Review Form  [PDF]  [DOC]
    • SSO Sample Sponsor Monitor Site Review Form  [PDF]  [DOC]
    • SFSP Forms (see the SFSP Application Materials Web page)
  • Special Milk Program (SMP) Daily Milk Count Form  [PDF]   [DOC]   [Excel]   Revised August 2016
    • Instructions for SMP Daily Milk Count Form  [PDF]  Revised August 2016
  • Summer Food Service Program Forms
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 11/9/2016 12:21:38 PM