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  • Health and Nutrition Services
  • National School Lunch Program and School Breakfast Program - Program Forms and Resources

National School Lunch Program and School Breakfast Program - Program Forms and Resources

 

Calendars

  • NSLP At a Glance Calendar
  • NSLP At a Glance Calendar for Special Provision Options
  • Verification Best Practices Calendar
  • Claiming Calendar

 

Checklists

  • School Meal Programs Application and USDA Foods Checklist

REMINDER: Per USDA, the Program Forms should be distributed on or around the beginning of the school year. *Forms cannot be distributed before July 1.

Application Packet

  • Parent Letter for School Meals (English) (Spanish)
  • Instructions for Household Application for Free and Reduced-Price Meals (English) (Spanish)
  • Household Application for Free and Reduced-Price Meals (English) (Spanish)
  • Parent/Guardian Consent for Sharing Information (English) (Spanish)
  • Foster Outreach Letter – USDA Sample Template (PDF) (Word)
  • USDA Translated School Meal Application Materials

 

Parent Letters for Special Provision Options

  • Parent Letter for Provision 2/3 Non-Base Year & for CEP (English) (Spanish)

 

Parent Letters for the Special Milk Program

  • Parent Letter collects applications and charges (English) (Spanish)
    • *Use the instructions and the household application for free and reduced-price meals posted above.
  • Parent Letter, does not collect applications and charges (English) (Spanish)
  • Parent Letter, does not collect applications and does not charge (English) (Spanish)

 

Certification and Benefit Issuance

  • Income Eligibility Guidelines (IEGs) for SY 23-24
  • Income Eligibility Guidelines (IEGs) for SY 24-25
  • Income Eligibility Guidelines (IEGs) for SY 25-26
  • Notification of Benefits Letter, School Meals (English) (Spanish)
  • Notification of Benefits Letter, Special Milk (English) (Spanish)
  • Notification for Free School Meals Letter, Direct Certification (English) (Spanish)
  • Notification of Reduced-Price School Meals Letter, Direct Certification - Medicaid (English) (Spanish)

 

Verifying Household Applications

  • Student Eligibility Checklist
  • Error-Prone Guidelines (PDF) (Excel)
  • Verification Tracking Form
  • Verification for the Cause Tracking Form
  • Notification of Verification Letter (English) (Spanish)
  • Letter of Verification Results (English) (Spanish)
  • It's More Than a Meal Application (English)  (Spanish)
  • Sources of Acceptable Income (English) (Spanish)
  • Second Review Aggregate Tool

  • Adult Meal Pricing Tool
  • Attendance Factor Calculation Form
  • Capital Expenditure Pre-Approval Request Form (Pre-Approved List)
    • Complete and submit form via HelpDesk using HNS Service Request – Other – Select: Capital Expenditure Pre-Approval Request Form
  • CNP Procurement Procedures 
  • CNP Written Code of Conduct
  • Common Logon Form (Adobe Sign)
  • Non-Program Food Revenue Tool & Calculator
  • Paid Lunch Equity (PLE) Tool
  • Net Cash Resources Worksheet (PDF)
  • Excess Cash Spending Plan
  • Request for One-Time Exception Form
  • State of Arizona W-9 Form
  • State of Arizona ACH Authorization Form

  • Prototype (Template) Hazard Analysis Critical Control Point (HACCP) Food Safety Plan
  • Cooler Freezer Temperature Log
  • Cooling Study Temperature Log
  • Damaged Discarded Product Log
  • Dish Machine Temperature Log
  • Dry Storage Temperature Log
  • Milk Cooler and Cleaning Temperature Log
  • Receiving Log
  • Reporting Issues with USDA Foods
  • Sanitizer Test Strip Log
  • Thermometer Calibration Log

  • Orientation to the Fresh Fruit and Vegetable Program
  • FFVP Addendum to the Food Program Permanent Service Agreement
  • FFVP Letter for Teachers Template
  • FFVP Standard Operating Procedure (SOP) Template
  • FFVP Production Record Template
  • FFVP Site Self-Monitoring Form
  • FFVP Labor Log Template
  • FFVP Monthly Service Planner SY 24-25

  • Local Wellness Policy Fillable Template
  • ADE Activity and Assessment Tool (District version) (School version)
  • Local Wellness Policy Assessment Comparison with a Model Policy
  • Local Wellness Policy Assessment Reporting Template: 4-box Design School & District Template
  • Local Wellness Policy Assessment Reporting Template: Wellness Report Card (District or school template) (Sample)

 

  • Production Record (with menu contributions) (PDF)
  • Production Record (no menu contributions) (PDF)
  • Production Record for Multiple Grades (PDF) (Word)
  • Production Record for Afterschool Care Snack Program (PDF)
  • Standardized Recipe Template
  • Vegetable Subgroup Planner
  • Vegetable Subgroup Quick Guide

 

Crediting Meal Components

  • Fresh Fruit Portion Guide
  • Fresh Vegetable Portion Guide
  • Fruit Resource for the National School Lunch and School Breakfast Programs
  • Milk Resource for the National School Lunch and School Breakfast Programs
  • Meat and Meat Alternatives Resource for the National School Lunch and School Breakfast Programs
  • Vegetable Resource for the National School Lunch and School Breakfast Programs
  • Whole Grain Resource for the National School Lunch and School Breakfast Programs
  • How to Credit Grains Using the Food Buying Guide

 

Weekly Menu Planners (Includes 3-Day, 4-Day, 5-Day, 6-Day, 7-Day Planners)

  • Breakfast Weekly Menu Planner
  • Lunch Weekly Menu Planner

 

Point of Service (POS) Sample Signage

  • USDA OVS Posters and Tip Sheets
  • Offer vs. Serve Poster – Sample from Connecticut Department of Education
  • Serve Only Sign - Lunch
  • Offer vs. Serve Sign - Lunch
  • Serve Only Sign - Breakfast
  • Offer vs. Serve Sign - Breakfast

  • Buy American Exception Form
  • Fundraising Exemption Request
  • Internal On-Site Monitoring Form - Afterschool Care Snack Program
  • Internal On-Site Monitoring Form – Breakfast
  • Internal On-Site Monitoring Form – Lunch
  • Daily Edit Check Worksheet (for sites operating regular NSLP and Special Assistance Provision Base Year)(PDF) (Excel)
  • Simplified Daily Edit Check Worksheet (for sites operating CEP and Special Assistance Provision Non-Base Year)(PDF) (Excel)
  • Memorandum of Understanding (PDF) (Word)
  • Record Keeping List
  • Smart Snacks Calculator
  • Medical Statement for Students with Special Dietary Accommodations (English) (Spanish)

  • Access to CNP Applications Guidance (CNPWeb, CNP Direct Certification / Direct Verification, and CNP Verification)
    • *Don’t have an Entity Administrator? Fill out this form.
  • Health and Nutrition Services Entity Data Form
    • HelpDesk Add/Change/Delete
      • Log into ADEConnect
      • Click 'Help'
      • Click 'Go to Help Desk'
      • Click 'New Request'
      • Locate Health and Nutrition Services templates
      • Select 'HNS Add/Change/Delete Form'
      • Complete all required fields and applicable optional fields within HelpDesk's Add/Change/Delete form
      • *User/Requestor submitting Add/Change/Delete form must be submitted by an Authorized Signer listed on the Food Permanent Service Agreement
    • Manual Add/Change/Delete Form (print, sign, scan, and email)
  • Food Program Permanent Service Agreement (FPPSA)
    • Manual FPPSA (print, sign 1 original, mail to ADE for approval)
      • HNS #11-2020: Revised Instructions for FPPSA for School Food Authorities (SFAs)
    • Electronic FPPSA (complete initiation form, agreement is emailed to signers directly by AdobeSign, electronic signature)
      • HNS #11-2020: Revised Instructions for FPPSA for School Food Authorities (SFAs)
      • FPPSA Initiation Form for AdobeSign
  • Free and Reduced Price Policy Statement
    • If applicable to your operation, please also include:
      • SFA At-Risk Afterschool Meals Responsible Principals Addendum (PDF)
      • Addendum- Non-Pricing
      • Addendum- RCCI without Day Students
      • Addendum – Special Milk Pricing
      • Public Media Release
      • Reimbursement Rates for SY 24-25
  • Unique Entity Identifier (UEI) lookup or request a UEI by visiting https://sam.gov/content/duns-uei

  • Public Media Release

  • Training Tracker (Director)
  • Training Tracker (Manager)
  • Training Tracker (Full-Time Staff)
  • Training Tracker (Part-Time Staff)
  • Training Tracker (Non-Program Staff)
  • Hiring Tracker for Directors Hired after July 1, 2015 (10,000+ enrollment)
  • Hiring Tracker for Directors Hired after July 1, 2015 (2,500-9,999 enrollment)
  • Hiring Tracker for Directors Hired after July 1, 2015 (less than 2,499 enrollment)

Community Eligibility Provision (CEP)

  • CEP Application Information
  • CEP Participation Form
  • CEP Eligibility Worksheet
  • CEP Monthly Federal Reimbursement Estimator (Excel)
  • CEP Grouping Calculator
  • CEP Parent Outreach Letter
  • Annual Identified Student Percentage (ISP) Form
  • ISP Calculation Worksheet for LEAs
  • CEP Fact Sheet

 

Special Assistance Provisions 2 and 3

  • Financial Analysis Tool
  • Special Assistance Application
  • Special Assistance Extension Application Packet

 

Free and Reduced Priced Policy Statement Addendums

  • Addendum- Provision 2
  • Addendum- Provision 3
  • Addendum- Community Eligibility Provision (CEP)

  • Inter-Agency Agreement (Checklist) (Template)
  • Informal Catering Contract Agreement (Checklist) (Template) 
  • Sample Catering Specifications and Requirements
  • Certificate of Independent Price Determination

 

  • Administrators and School Leaders
    • Free and Reduced Data and use with other programs
    • SUN Bucks
    • Prospective Waiver Requests
  • Parents and Families
    • Find a Participating Summer Food Service Site
    • Paying for Meals
    • SUN Bucks
    • Menu Requirements
    • Additional Benefits for Children and Families
  • Child Nutrition Program Operators
    • National School Lunch Program and School Breakfast Program
    • Child and Adult Care Food Program
    • Afterschool Care Snack Program and At-Risk Afterschool Meals
    • Summer Meal Service
    • Staying on Track Monthly Webinar
  • Peer to Peer Support for Child Nutrition Professionals
  • Free and Reduced-Price Percentage Report
  • HNS/USDA Memos
  • Civil Rights
  • Submit Data Request
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