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  • SY 2022-2023
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  • 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

  • SY 22-23 NSLP At a Glance Calendar
  • SY 22-23 NSLP At a Glance Calendar for Special Provision Options
  • Verification Best Practices Calendar
  • Claiming Calendar

Program Forms for School Year 2022-2023 have been updated.

REMINDER: As 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 22-23 (English) (Spanish)
  • 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)

 

Verifying Household Applications

  • Error-Prone Guidelines (PDF) (Excel)
  • Verification Tracking Form
  • Verification for Cause Tracking Form
  • Notification of Verification Letter (English) (Spanish)
  • Letter of Verification Results (English) (Spanish)
  • It's More Than a Meal Application

  • Adult Meal Pricing Tool SY 22-23
  • Attendance Factor Calculation Form
  • Capital Expenditure Pre-Approval Request Form (Pre Approved List)
  • CNP Procurement Procedures 
  • CNP Written Code of Conduct
  • Common Logon Permissions (AFR)
  • 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
  • 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 22-23

  • 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
  • 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)
  • Food Distribution Program Delivery Information
  • Memorandum of Understanding (PDF) (Word)
  • Record Keeping List
  • Smart Snacks Calculator
  • Medical Statement for Students with Special Dietary Accommodations

  • 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
    • Manual ADD/CHANGE/DELETE Form (print, sign, scan and email)
    • Electronic ADD/CHANGE/DELETE Web Form (access and fill out online, electronic signature)
      • The “Applicable Program” at the top of the form MUST be selected in order for the request to be processed.
      • The initiator of the form must also be an authorized signer.
  • 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 22-23

  • 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 for SY 2023-2024
  • 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

 

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 Catering Agreement (Checklist) (Template) 
  • 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
    • New Legislation
    • Free and Reduced Data and use with other programs
    • Summer P-EBT
  • Parents and Families
    • Paying for Meals Again
    • Summer P-EBT
    • Menu Requirements
    • Additional Benefits for Children and Families
  • Child Nutrition Program Operators
    • Child Nutrition Flexibilities
    • 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

Contact

  • Health & Nutrition Services
  • (602) 542-8700
  • [email protected]

From the Health and Nutrition Services Blog

Health and Nutrition Services Announces the Availability of the 2023 Summer Food Service Program Wed, Feb 1 2023

The Arizona Department of Education Health and Nutrition Services (HNS) is pleased to announce the availability of the Summer Food Service Program (SFSP) during summer 2023. 

Congratulations to the School Year 2021-2022 BRAVOcado! Excellence Awardees! Tue, Oct 11 2022

The Arizona Department of Education Recognizes Schools for Exemplary Fresh Fruit and Vegetable Programs  

The Arizona Department of Education Health and Nutrition Services is pleased to announce the Program Year 2021-2022 BRAVOcado! awardees for excellent Fresh Fruit and Vegetable Program (FFVP) operations. The BRAVOcado! Excellence Award is given to schools that demonstrate exemplary FFVP service and commitment to promoting fruit and vegetable consumption and healthy lifestyles to their students.

The FFVP BRAVOcado! Excellence Award recognizes schools that go above and beyond to operate a phenomenal FFVP program. To be eligible for the award, sites must meet criteria related to variety of produce items served, frequency of service, frequency of nutrition education, frequency of serving local produce, development of site-level and outside partnerships, and more!

The following three School Food Authorities went above and beyond and received the award this year. Congratulations to all awardees!

  • Concho Elementary School 
  • Concordia Charter School 
  • Southgate Academy, Inc.

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