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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

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

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

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 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 ACH Authorization Form
  • USDA Foods and the Annual Financial Report

  • 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

  • Overview of the Fresh Fruit and Vegetable Program for SY 2022-2023 (Recording) (Slides)
  • 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 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 (District template) (School 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

  • 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

  • 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- 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

  • 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 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)

  • 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
  • Parents and Families
    • Paying for Meals Again
    • Menu Requirements
  • 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

2022 Farm Fresh Challenge Fri, Oct 22 2021

2022 Farm Fresh Challenge

Interested in Creating Your Kitchen? Fri, May 7 2021

The Arizona Department of Education (ADE) is excited to announce a new partnership with the Chef Ann Foundation, Life Time Foundation, and Whole Kids Foundation! These organizations are part of the newly formed ScratchWorks Collective and are dedicated to improving the quality of school meals and love sharing their expertise with school nutrition professionals. These partners look forward to supporting 10 Arizona Local Educational Agencies (LEAs) in a three-phase program to help operators regain their kitchens and menus as they recover from the impacts of the COVID-19 pandemic. The Chef Ann Foundation will kick-off this collaborative work by sending a culinary trained school food operational expert to each of the selected LEAs for a one-day on-site consultation to create a two-year plan with built-in mentoring designed to transform your kitchens, develop your staff, and take control of your finances to support the menu of your dreams. 

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