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Allergy/Special Diet Request

Federal regulations require Child Nutrition Programs Sponsors to offer to all participants’ breakfasts, lunches, suppers, snacks, and milk that meet the meal requirements identified in the individual program regulations. Federal regulations further require Sponsors to make substitutions to the standard meal requirements for participants who are considered disabled and whose disability restricts their diet. A Sponsor may, at its discretion, make substitutions for individual participants who are not "disabled persons" but are unable to consume a food item because of medical or other special dietary needs. Below are forms, resources, and guidance to be used for special dietary needs.

Medical statement forms for medical participants with disabilities can be found below or on the Oregon Department of Education CNP Special Dietary Needs Form Page.

Medical Statement Participants with Disabilities (see forms below)

Part I: Write your child's name
Part II: This section can only be completed by your child's physician

Every section must be completed: 

  • Diagnosis 
  • Does the disability restrict the patient's diet? Yes or No
  • If Yes, list how
  • Foods to be omitted from diet
  • Foods to be substituted

 

SUPPORTING DOCUMENTS

MEDICAL STATEMENT TO REQUEST SPECIAL MEAL AND/OR ACCOMMODATIONS – ENGLISH

MEDICAL STATEMENT TO REQUEST SPECIAL MEAL AND/OR ACCOMMODATIONS – RUSSIAN

MEDICAL STATEMENT TO REQUEST SPECIAL MEAL AND/OR ACCOMMODATIONS – SIMPLIFIED CHINESE

MEDICAL STATEMENT TO REQUEST SPECIAL MEAL AND/OR ACCOMMODATIONS – SPANISH 

MEDICAL STATEMENT TO REQUEST SPECIAL MEAL AND/OR ACCOMMODATIONS – VIETNAMESE 

If you have questions, please contact the Nutrition Services Department.
 

1331 NW Eastman Parkway
Gresham Oregon 97030
Office: (503) 261-4590

ns-office@partner.gresham.k12.or.us