Special Diet Statement

School Food Authorities (SFAs) must make reasonable substitutions to meals on a case-by-case basis for children who are considered to have a disability that restricts their diet [7 CFR 210.10(m)]. According to the ADA Amendments Act, most physical and mental impairments will constitute a disability.

SFAs are not required to accommodate special dietary requests that do not constitute a disability, including requests related to religious or moral convictions or personal preference. If these requests are accommodated, SFAs must ensure all USDA meal pattern and nutrient requirements are met.


1. Download a Special Diet Statement form (below) and have it completed and signed by a medical professional (e.g. a licensed physician, physician assistant, or an advanced practice registered nurse, such as a certified nurse practitioner.) prior to receiving dietary accommodation. Signed documentation from a medical professional, on medical facility letterhead, outlining dietary accommodations is also acceptable.

2. Submit a completed form to the health office at your child's school.

3. The school nurse will review the documentation and may contact parent, medical professional, and/or Child Nutrition with questions.

4. The school nurse will inform the kitchen manager and child’s teacher about the special diet request, along with directions for the diet, as needed.

Parent/guardian is responsible for providing a new special diet statement if there are any updates or changes to the current dietary form on file.  It is not necessary to provide a new special diet statement every school year if there are no dietary changes.  Any medications involved with allergies require an annual medical doctor’s signature.
In the case of food allergies or diabetes, parents/guardians may also want to notify their child’s teacher, school age care staff and others who should know to ensure child’s safety during school and school-sponsored activities.

Note: Parents may provide a written request for lactose-reduced milk if their child is lactose intolerant without a physician’s signature.