Overview

School Nutrition Programs | Manuals | Program Guidance | Resources | Nutrition Education

The forms below are for the U.S. Department of Agriculture's (USDA) school nutrition programs, including the School Breakfast Program (SBP), National School Lunch Program (NSLP), Seamless Summer Option (SSO) of the NSLP, Afterschool Snack Program (ASP) of the NSLP, Fresh Fruit and Vegetable Program (FFVP), and Special Milk Program (SMP). For guidance on program requirements, visit the CSDE's Program Guidance for School Nutrition Programs webpage.

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A

Action Planning 

• Action Planning Form
• Addenda
• Addendum A: Sharing Information with Other Programs (English)
• Addendum A: Sharing Information with Other Programs (Spanish)
  •  Apéndice A: Divulgación de información con otros programas 
• Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY) (English)
• Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY) (Spanish)
  • ¿Su familia necesita seguro médico? Connecticut ofrece cobertura a bajo costo o gratuita!
• Addendum C: Information on the Supplemental Nutrition Assistance Program (SNAP) (English)
• Addendum C: Information on the Supplemental Nutrition Assistance Program (SNAP) (Spanish)
  • Anexo C: Información sobre el Programa Asistencial de Nutrición Suplementaria (SNAP)

Administrative Review

• Menu Documentation Organizational Tool (MDOT) 
• Sample Administrative Review Organizational Tool (AROT)

Afterschool Snack Program (ASP)

• ASP Daily Attendance and Snack Count Record for Schools that are not Site/Area Eligible
• ASP Daily Snack Count Record for Grades K-12 in Site/Area Eligible Schools
• ASP Daily Snack Count Record for Preschoolers in Site/Area Eligible Schools
• ASP Daily Snack Count and Production Record for Grades K-12 in Site/Area Eligible Schools
• ASP Daily Snack Count and Production Record for Preschoolers in Site/Area Eligible Schools
• ASP Monthly Attendance and Snack Count Record for Schools that are not Site/Area Eligible
• ASP Monthly Attendance and Snack Count Record in Site/Area Eligible Schools
• ASP On-site Monitoring Form
• ASP Production Record for Ages 1-2
  • ASP Production Record for Ages 3-4
  • Sample Completed ASP Production Record for Ages 3-4
• ASP Production Record for Grades K-12
  • Sample Completed ASP Production Record for Grades K-12
• ASP School Eligibility Checklist

Authorized Signatures

• Authorized Signatures Change Form
• Authorized Signatures Change Form Instructions

C

Certification of Meal Pattern Compliance

• Certification of Meal Pattern Compliance for School Nutrition Programs (CSDE webpage)

Civil Rights

• Sample Civil Rights Complaint Procedures for School Nutrition Programs

Claims

• Claim Form for School Meals
• Claim Form for School Meals: Instructions

Community Eligibility Provision (CEP)

• CEP Monthly Federal Reimbursement Estimator (USDA)
• CEP Participation Worksheet
• CEP Sample Parent Notification Letter (English)
• CEP Sample Parent Notification Letter (Spanish)
  • Carta para las familias de muestra sobre la Disposición de Elegibilidad Comunitaria (CEP)

Connecticut Nutrition Standards (CNS)

• CNS Worksheet 1: Evaluating Snacks for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 2: Evaluating Yogurt and Pudding for Compliance with the Connecticut Nutrition Standards 
• CNS Worksheet 3: Evaluating Smoothies for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 4: Evaluating Fruits and Vegetables for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 5: Evaluating Soups for Compliance with the Connecticut Nutrition Standards 
• CNS Worksheet 6: Evaluating Cooked Grains for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 7: Evaluating Entrees Sold Only A La Carte for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 8: Evaluating Non-entree Combination Foods for Compliance with the Connecticut Nutrition Standards
• CNS Worksheet 9: Nutrient Analysis of Recipes
• CNS Worksheet 10: Evaluating Recipes for Sugars

D

Disclosure Release

• Disclosure Release Request for Free or Reduced Eligibility Status (CSDE)
• USDA Memo SP 16-2016, CACFP 06-2016, SFSP 10-2016: Disclosure Requirements for the Child Nutrition Programs

District Benefit Issuance

• District Benefit Issuance Excel Spreadsheet (DBIES)

E

Edit Check Forms

• CEP Edit Check Worksheet and Instructions
• CEP Participation Worksheet
• Edit Check Worksheet for Lunch
  • Instructions for Edit Check Worksheet for Lunch
• Edit Check Worksheet for Breakfast and Lunch
  • Instructions for Edit Check Worksheet for Breakfast and Lunch

Equipment

• Equipment Purchase Approval Request Form
• Equipment Purchase Capital Expenditure Approved List for School Food Authorities
• Equipment Purchase Prior Approval Process for School Food Authorities

Exemption Requests

• Lunch Period Waiver: Circular Letter C-9: Federal and State Requirements for Provision and Timeframe of Daily Lunch Period for Students
• Meal Pattern Exception Request Form for Residential Child Care Institutions (RCCIs)
• Weekend or Vacation Waiver: FNS 786-7 Rev. 2: Reimbursement for Meals and Milk Served on Weekends

F

Food Safety

• Alternate QFO Statement
• Food Service Employee Training Record for Sanitation and Food Safety 
• On-site Training Record for Sanitation and Food Safety
• Qualified Food Operator (QFO) Responsibilities for Connecticut Child Nutrition Programs
• Refrigerator and Freezer Temperature Control Record

Food Service Management Company

• Exhibit I: Sample School Food Authority (SFA)/Food Service Management Company (FSMC) Monitoring Form

Free and Reduced-price Meals

• Family Application

• Application for Free and Reduced-price School Meals or Free Milk (English)
• Application for Free and Reduced-price School Meals or Free Milk (Spanish)
  • Solicitud para comidas gratuitas y a precio reducido en la escuela, o para leche gratuita 
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free and Reduced-price School Meals (English)
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free and Reduced-price School Meals (Spanish)
  • Preguntas frecuentes sobre comidas gratuitas o a precio reducido en la escuela
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free School Milk (English)
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free School Milk (Spanish)
  • Plantilla para preguntas frecuentes sobre leche gratuita en la escuela
• Foreign Language Translations for Free and Reduced-price Application Forms (USDA)

• Parent/Guardian Notification Letter

• Sample Parent/Guardian Letter: Notification of Change in Free Eligibility Due to a Transfer from a CEP School to a Non-CEP School (English)
• Sample Parent/Guardian Letter: Notification of Change in Free Eligibility Due to a Transfer from a CEP School to a Non-CEP School (Spanish)
  • Notificación de cambio en la elegibilidad gratuita debido a una transferencia de una escuela con Community Eligibility Program (CEP) a una escuela sin CEP
• Sample Parent/Guardian Notification Letter (English)
• Sample Parent/Guardian Notification Letter (Spanish)
  • Carta de notificación para el padre/tutor
• Sample Parent/Guardian Notification Letters for Direct Certification
  • Version 1: SNAP, TFA, Medicaid (English)
  • Version 1: SNAP, TFA, Medicaid (Spanish)
    • Carta de notificación al padre/tutor versión 1: Elegibilidad establecida por medio de certificación directa en función del Programa de Responsabilidad Nutricional Escolar (SNAP, Supplemental Nutrition Assistance Program) o de los beneficios de Asistencia  Temporal Familiar (TFA, Temporary Familiy Assistance) o Medicaid
  • Version 2: Foster Child, Homeless, Runaway, Head Start (English)
  • Version 2: Foster Child, Homeless, Runaway, Head Start (Spanish)
    • Carta de Notificación del padre/madre/tutor versión 2: Elegibilidad establecida por medio de certificación directa en función de estado de niño en acogimiento familiar, sin hogar, fugado o del programa Head Start
  • Version 3: Medicaid Benefits Reduced-price Meals (English)
  • Version 3: Medicaid Benefits Reduced-price Meals (Spanish) 
    • Carta de notificación al padre/tutor versión 3: Elegibilidad establecida a precio reducido por medio de certificación directa en función de Beneficios de Medicaid – Comidas a Precio Reducido

H

Healthy Food Certification (HFC)

• HFC Documentation Form 1: Purchased Foods and Beverages Sold in Cafeteria
• HFC Documentation Form 2: School-made Foods Sold in Cafeteria
• HFC Documentation Form 3: Foods and Beverages Sold in Vending Machines
• HFC Documentation Form 4: Foods and Beverages Sold in School Stores
• HFC Documentation Form 5: Food and Beverage Fundraisers
• HFC Documentation Form 6: Foods and Beverages Sold from Other Sources
• HFC Documentation Form 7: School-made Foods Sold from Other Sources
• Sample Fundraiser Form for HFC

I

Interschool Agreements

• Full-service Interschool Agreement Form
• Recipient Site Vended Interschool Agreement

M

Meal Counting and Claiming

• Meal Application and Data Management Process Form
• Site Information on Money Collection and Point-of-Service (POS) Meal Count Systems Form

Media Release (see Public Media Release)

Medical Statement

• Medical Statement for Meal Modifications in School Nutrition Programs (English)
• Medical Statement for Meal Modifications in School Nutrition Programs (Spanish)
  • Declaración médica para la modificación de alimentos en los programas de nutrición escolar
• Guidance and Instructions: Medical Statement for Meal Modifications in School Nutrition Programs (English)
• Guidance and Instructions: Medical Statement for Meal Modifications in School Nutrition Programs (Spanish)
  • Orientación e instrucciones: Declaración médica para la modificación de alimentos en los programas de nutrición escolar

Menu Forms for Preschoolers

• Breakfast Five-day Menu Planning Form for Ages 1-2
• Breakfast Five-day Menu Planning Form for Ages 3-4
• Breakfast Four-day Menu Planning Form for Ages 1-2
• Breakfast Four-day Menu Planning Form for Ages 3-4
• Breakfast Seven-day Menu Planning Form for Ages 1-2
• Breakfast Seven-day Menu Planning Form for Ages 3-4
• Lunch Five-day Menu Planning Form for Ages 1-2
• Lunch Five-day Menu Planning Form for Ages 3-4
• Lunch Four-day Menu Planning Form for Ages 1-2 
• Lunch Four-day Menu Planning Form for Ages 3-4
• Lunch Seven-day Menu Planning Form for Ages 1-2
• Lunch Seven-day Menu Planning Form for Ages 3-4

Menu Planning Checklist for Lunch for Grades K-12

• Five-day Week Lunch Menu Planning Checklist: Grades K-5
• Five-day Week Lunch Menu Planning Checklist: Grades 6-8
• Five-day Week Lunch Menu Planning Checklist: Grades 9-12
• Five-day Week Lunch Menu Planning Checklist:Grades K-8
• Seven-day Week Lunch Menu Planning Checklist:Grades 6-8
• Seven-day Week Lunch Menu Planning Checklist: Grades K-5
• Seven-day Week Lunch Menu Planning Checklist: Grades 9-12
• Seven-day Week Lunch Menu Planning Checklist: Grades K-8

Monitoring Forms

• On-site School Review Checklist for the NSLP
• On-site School Review Checklist for the SBP
• Overview of Meal Counting and Claiming Process

Nonprogram Foods

• Nonprogram Pricing Worksheet: Adult Meals (CSDE)
• Nonprogram Pricing Worksheet: A La Carte Sales (CSDE)
• Nonprogram Revenue Calculator (USDA)
• Nonprogram Revenue Tool for Five-day Reference Period (Kansas Department of Education)

P

Paid Lunch Equity

• Paid Lunch Equity Calculations and Tool 2019-20

Policy Statement

• Policy Statement for Free and Reduced-price Meals, Afterschool Snack Programs, and Free Milk 

Procurement

• Buy American Justification Form
• Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion – Lower Tier Covered Transactions
• Sample Code of Conduct for Procurement
• Sample Procurement Procedures for School Food Authorities (Version 1)
• Sample Procurement Procedures for School Food Authorities (Version 2)

Production Records

• Food Components

• Production Record for Ages 1-4 (Preschool) in School Nutrition Programs
• Production Record for Ages 3-4 (Preschool) in School Nutrition Programs
• Production Record for Ages 3-4 (Preschool) and Grades K-8 in School Nutrition Programs
• Production Record for Ages 3-4 (Preschool) and Grades K-12 in School Nutrition Programs
• Production Record for Grades K-5 in School Nutrition Programs
• Production Record for Grades 6-8 in School Nutrition Programs
• Production Record for Grades 9-12 in School Nutrition Programs
• Production Record for Grades K-8 in School Nutrition Programs
• Production Record for Grades K-12 in School Nutrition Programs

• Food Items

• Production Record for Ages 1-4 (Preschool) in School Nutrition Programs
• Production Record for Ages 3-4 (Preschool) in School Nutrition Programs
• Production Record for Ages 3-4 (Preschool) and Grades K-12 in School Nutrition Programs
• Production Record for Grades K-5 in School Nutrition Programs
• Production Record for Grades 6-8 in School Nutrition Programs
• Production Record for Grades 9-12 in School Nutrition Programs
• Production Record for Grades K-8 in School Nutrition Programs
• Production Record for Grades K-12 in School Nutrition Programs

Professional Standards

• Professional Standards Tracking Log

Public Media Release

• Sample Public Media Release for Connecticut School Nutrition Programs

S

Seamless Summer Option (SSO)

• SSO Daily Meal Count
• SSO Weekly Meal Count Consolidation

Special Milk Program

• SMP Daily Milk Count Form (EXCEL)
• SMP Daily Milk Count Form (PDF)
• SMP Daily Milk Count Form Instructions
• Sample Completed SMP Daily Milk Count Form

Standardized Recipes

• Standardized Recipe Form for School Nutrition Programs

U

USDA Foods

• USDA Foods Transfer Request Form
• Worksheet for Calculating Direct Delivery of USDA Foods (Brown Box)
• Worksheet for Calculating Processed USDA Foods

V

Verification

• Letter of Verification Results and Adverse Action for Income Households (English)
• Letter of Verification Results and Adverse Action for Income Households (Spanish)
  • Ejemplo de carta de resultados de verificación y medida adversa para grupos familiares con ingresos
• Household Letter to Verify Eligibility (English)
• Household Letter to Verify Eligibility (Spanish)
  • Ejemplo de carta para el grupo familiar a fin de verificar la elegibilidad de la familia
• Household Letter: Second Notification to Verify Eligibility (English)
• Household Letter: Second Notification to Verify Eligibility (Spanish)
  • Ejemplo de carta para el hogar de segundo aviso para verificar la elegibilidad familiar
• Household Employer Letter (English)
• Household Employer Letter (Spanish)
  • Ejemplo de carta de empleador de grupo familiar
• Household Letter for Social Security Office (English)
• Household Letter for Social Security Office (Spanish)
  • Ejemplo de carta para grupo familiar de la Oficina del Seguro Social 
• Optional Household Letter: Notification of Continuation of Benefits as a Result of Verification (English)
• Optional Household Letter: Notification of Continuation of Benefits as a Result of Verification (Spanish)
  • Ejemplo de carta opcional para el grupo familiar: Notificación de continuación de beneficios como consecuencia de la verificación
• Sample Verification Selection Worksheet

Y

Yield Study

• Yield Study Data Form (CSDE)