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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

Checklists

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

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

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 Base Year (English) (Spanish)
    • *Use the instructions and the household application for free and reduced-price meals posted above.
  • Parent Letter for Provision 2/3 Non-Base Year (English) (Spanish)
  • Parent Letter for Community Eligibility (CEP) (English) (Spanish)
  • Parent Letter for Provision 2/3 Non-Base Year for Breakfast or Lunch only (English) (Spanish)
  • Parent Letter for non-pricing, no provisions (English) (Spanish)
    • *Use the instructions and the household application for free and reduced-price meals posted above.

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 20-21 (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 20-21
  • Verification Tracking Form
  • Verification for Cause Tracking Form
  • Notification of Verification Letter (English) (Spanish)
  • Letter of Verification Results (English) (Spanish)

  • 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

  • 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

  • The Monthly Checklist: FFVP
  • FFVP Addendum to the Food Program Permanent Service Agreement Template
  • FFVP Letter for Teachers Template
  • FFVP Standard Operating Procedure (SOP) Template
  • FFVP Equipment Purchase Pre-Approval Form
  • FFVP Expenditure Tracking Workbook
  • FFVP Local Produce Purchase Trackers
  • FFVP Production Record Template
  • FFVP Labor Log Template
  • FFVP Monthly Service Planners
    • Period 1 (July-September)
    • Period 2 (October-December)
    • Period 2 (January-March)
    • Period 2 (April-June)

  • 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)

 

  • 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

  • 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 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 20-21

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

 

     

    • COVID-19: Guidance to Child Nutrition Operators
    • Providing Meals During the School Day
      • National School Lunch Program and School Breakfast Program
    • Providing Meals/Snacks in Childcare and Adult Care
      • Child Care Centers
      • Family Day Care Homes
      • Adult Care Centers
      • Emergency Shelters
    • Providing Meals/Snacks After School
      • Afterschool Care Snack Program and At-Risk Afterschool Meals
    • Providing Meals/Snacks During the Summer
      • Summer Food Service Program and Seamless Summer Option
    • HNS/USDA Memos
    • Free and Reduced-Price Percentage Report
    • Civil Rights
    • Submit Data Request

    Contact

    • Health & Nutrition Services
    • (602) 542-8700

    From the Health and Nutrition Services Blog

    Arizona Farm to School Network Virtual Gathering. Register today! Wed, Feb 24 2021

    Don’t miss this year’s virtual gathering. Join us to celebrate Arizona's Farm to School progress despite COVID-19!

     

    Congratulations to Concordia Charter School for receiving a School Year 2019-2020 FFVP BRAVOcado! Excellence Award! Tue, Nov 17 2020

    ADE has awarded Concordia Charter School a FFVP BRAVOcado! Excellence Award for their Fresh Fruit and Vegetable Program (FFVP) operations during school year 2019-2020.

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