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

Calendars and Checklists

Calendars

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

Checklists

• The Monthly Checklist for School Food Authorities
• The Monthly Checklist for School Food Authorities: Special Provision Options

Civil Rights

• Civil Rights Compliance Form
• Procedures for Complaints of Discrimination
• And Justice for All Poster - Must print size 11"X17"

Eligibility Documents for School Meal Benefits

Program Forms for School Year 2021-2022 have been updated to indicate that breakfast and lunch are free for all students this year. Please reference Memorandum HNS # 17-2021 (coming soon) for more information.

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 21-22 (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 Worksheet for SY 21-22
• 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 (English) (Spanish)

Financial

• Adult Meal Pricing Tool SY 20-21
• Attendance Factor Calculation Form (Fillable) (Non Fillable)
• Capital Expenditure Pre-Approval Request Form (Pre Appproved List)
• Common Logon Permissions (AFR)
• Excess Cash Spending Plan (PDF) (Excel)
• Non-Program Food Revenue Tool & Calculator
• Paid Lunch Equity (PLE) Tool for SY 20-21
  • Net Cash Resources Worksheet (PDF) (Excel)
• Request for One-Time Exception Form
• State of Arizona W-9 Form
• State of Arizona Direct Deposit Form
• USDA Foods and the Annual Financial Report

Food/Health Safety

• 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

Fresh Fruit and Vegetable Program (FFVP)

• FFVP Addendum to the Food Program Permanent Service Agreement Template
• FFVP Letter for Teachers Template
• FFVP Standard Operating Procedure (SOP) Template
• FFVP Production Record Template
• FFVP Labor Log Template

Local Wellness Policy

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

Menu Planning

• Production Record (with menu contributions) (PDF) (Word)
• Production Record (no menu contributions) (PDF) (Word)
• ADE's Updated Fillable Production Record Template (PDF)
• Production Record for Multiple Grades (PDF) (Word)
• Production Record for Afterschool Care Snack Program (PDF) (Word)
• Standardized Recipe Template
• Vegetable Subgroup Planner
• Vegetable Subgroup Quick Guide (English) (Spanish)

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

Point of Service (POS) Sample Signage

• Build a Healthy Lunch for OVS (English) (Spanish)
• USDA OVS Posters and Tip Sheets
• Offer vs. Serve Poster – Sample from Connecticut Department of Education
• Offer vs. Serve for Breakfast
• Serve Only- Breakfast
• Serve Only- Lunch

Operational

• 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

Organizational

• 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 2 originals, 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- Provision 2
    • Addendum- Provision 3
    • Addendum- Community Eligibility Provision (CEP)
    • Addendum- Non-Pricing
    • Addendum- RCCI without Day Students
    • Addendum – Special Milk Pricing
    • Public Media Release
    • Reimbursement Rates for SY 21-22

Outreach

• Public Media Release

Professional Standards

• 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)

Special Provision Options

Community Eligibility Provision (CEP)

• CEP Application Packet
• 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 (Updated November 2013)

Vendor Contracts

• Inter-Agency Agreement (IAA) Template 2021-2022
• IAA Catering Agreement Checklist
• IAA Catering Template 2021-2022
• Sample Catering Specifications and Requirements
• NSLP Catering Contract Agreement Checklist
• NSLP Informal Catering Contract Template 2021-2022
• Certificate of Independent Price Determination