Modified Meal Request Form

  • In order to better serve our students with specialized dietary needs, an Annual Modified Meal Request form must be completed each school year. The completed Annual Modified Meal Request form will not be carried over from year to year. The parent or guardian is required to submit a new form signed by the student’s physician or medical authority. Recognized medical authorities include physicians, physician assistants, nurse practitioners, or registered dietitians. If the student does not eat or follow the modified meal for five school days, the modified meal(s) will be cancelled. Modified meals cannot be provided to accommodate religious preferences, personal diet modifications or food dislikes.

    Modified Meal Request Form and Instructions