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.

Note: The date in italics after each document is the most current revision date.

 

A   B   C   D   E   F   G   H   I   J   K   L   M   N   O   P   Q   R   S   T   U   V   W   X   Y   Z  

A

Action Planning 

• Action Planning Form  July 2019
• Addenda (Free and Reduced Applications)
• Addendum A: Sharing Information with Other Programs (English)  June 2020
• Addendum A: Sharing Information with Other Programs (Spanish)  June 2020
  •  Apéndice A: Divulgación de información con otros programas June 2020
• Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY) (English)  June 2020
• Addendum B: Healthcare for Uninsured Kids and Youth (HUSKY) (Spanish)  June 2020
  • ¿Su familia necesita seguro médico? Connecticut ofrece cobertura a bajo costo o gratuita! June 2020
• Addendum C: Information on the Supplemental Nutrition Assistance Program (SNAP) (English)  September 2019
• Addendum C: Information on the Supplemental Nutrition Assistance Program (SNAP) (Spanish)  September 2019
  • Anexo C: Información sobre el Programa Asistencial de Nutrición Suplementaria (SNAP) septiembre 2019

Administrative Review

• Menu Documentation Organizational Tool (MDOT)  January 2020
• Sample Administrative Review Organizational Tool (AROT)  January 2020
• Sample Administrative Review Organizational Tool (AROT) for Residential Child Care Institutions (RCCIs) and 100 Percent Community Eligibility (CEP) Districts  January 2020   

Afterschool Snack Program (ASP)

• ASP Daily Attendance and Snack Count Record for Schools that are not Site/Area Eligible  August 2019
• ASP Daily Snack Count Record for Grades K-12 in Site/Area Eligible Schools  August 2019
• ASP Daily Snack Count Record for Preschoolers in Site/Area Eligible Schools  August 2019
• ASP Daily Snack Count and Production Record for Grades K-12 in Site/Area Eligible Schools  August 2019
• ASP Daily Snack Count and Production Record for Preschoolers in Site/Area Eligible Schools  August 2019
• ASP Monthly Attendance and Snack Count Record for Schools that are not Site/Area Eligible  August 2019
• ASP Monthly Attendance and Snack Count Record in Site/Area Eligible Schools  August 2019
• ASP On-site Monitoring Form  August 2019
• ASP Production Record for Ages 1-2  August 2019       
  • ASP Production Record for Ages 3-4  August 2019
  • Sample Completed ASP Production Record for Ages 3-4  August 2019
• ASP Production Record for Grades K-12  August 2019
  • Sample Completed ASP Production Record for Grades K-12  August 2019
• ASP School Eligibility Checklist  August 2019

Authorized Signatures

• Authorized Signatures Change Form  August 2019
• Authorized Signatures Change Form Instructions  August 2019

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  August 2019 

Community Eligibility Provision (CEP)

• CEP Monthly Federal Reimbursement Estimator (USDA)
• CEP Participation Worksheet  June 2020
• CEP Sample Parent Notification Letter (English)  July 2019
• CEP Sample Parent Notification Letter (Spanish)  August 2019
  • 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  November 2019
• CNS Worksheet 2: Evaluating Yogurt and Pudding for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 3: Evaluating Smoothies for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 4: Evaluating Fruits and Vegetables for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 5: Evaluating Soups for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 6: Evaluating Cooked Grains for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 7: Evaluating Entrees Sold Only A La Carte for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 8: Evaluating Non-entree Combination Foods for Compliance with the Connecticut Nutrition Standards  November 2019
• CNS Worksheet 9: Nutrient Analysis of Recipes  November 2019
• CNS Worksheet 10: Evaluating Recipes for Sugars  November 2019

D

Disclosure Release

• Disclosure Release Request for Free or Reduced Eligibility Status  August 2019
• USDA Memo SP 16-2016, CACFP 06-2016, SFSP 10-2016: Disclosure Requirements for the Child Nutrition Programs  December 2015

District Benefit Issuance

• District Benefit Issuance Excel Spreadsheet (DBIES)   February 2018

E

Edit Check Forms

• CEP Edit Check Worksheet and Instructions  February 2018
• CEP Participation Worksheet  April 2019
• Edit Check Worksheet for Lunch  November 2018
  • Instructions for Edit Check Worksheet for Lunch  August 2019
• Edit Check Worksheet for Breakfast and Lunch  May 2019
  • Instructions for Edit Check Worksheet for Breakfast and Lunch  August 2019

Equipment

• Equipment Purchase Approval Request Form  August 2019
• Equipment Purchase Capital Expenditure Approved List for School Food Authorities  August 2019
• Equipment Purchase Prior Approval Process for School Food Authorities  August 2019

Exemption Requests

• Lunch Period Waiver: Circular Letter C-9: Federal and State Requirements for Provision and Timeframe of Daily Lunch Period for Students  November 2000
• Meal Pattern Exception Request Form for Residential Child Care Institutions (RCCIs)  August 2019
• Weekend or Vacation Waiver: FNS 786-7 Rev. 2: Reimbursement for Meals and Milk Served on Weekends  November 2010

F

Food Distribution Program (see USDA Foods)

Food Safety

• Alternate QFO Statement  August 2019
• Food Service Employee Training Record for Sanitation and Food Safety  August 2019
• On-site Training Record for Sanitation and Food Safety  August 2019
• Qualified Food Operator (QFO) Responsibilities for Connecticut Child Nutrition Programs  August 2019
• Refrigerator and Freezer Temperature Control Record  August 2019

Food Service Management Company

• Exhibit I: Sample School Food Authority (SFA)/Food Service Management Company (FSMC) Monitoring Form  September 2019

Free and Reduced-price Meals

• Family Application

• Application for Free and Reduced-price School Meals or Free Milk (English)  June 2020
• Application for Free and Reduced-price School Meals or Free Milk (Spanish)  June 2020 
  • Solicitud para comidas gratuitas y a precio reducido en la escuela, o para leche gratuita  June 2020
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free and Reduced-price School Meals (English)  June 2020
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free and Reduced-price School Meals (Spanish)  June 2020
  • Preguntas frecuentes sobre comidas gratuitas o a precio reducido en la escuela  June 2020
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free School Milk (English)  June 2020
• Sample Parent/Guardian Letter: Frequently Asked Questions About Free School Milk (Spanish)  June 2020
  • Plantilla para preguntas frecuentes sobre leche gratuita en la escuela  June 2020
• Foreign Language Translations for Free and Reduced-price Application Forms (USDA webpage)

• 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)  June 2020
• Sample Parent/Guardian Letter: Notification of Change in Free Eligibility Due to a Transfer from a CEP School to a Non-CEP School (Spanish)  June 2020
  • Notificación de cambio en la elegibilidad gratuita debido a una transferencia de una escuela con Community Eligibility Program (CEP) a una escuela sin CEP  June 2020
• Sample Parent/Guardian Notification Letter (English)  June 2020
• Sample Parent/Guardian Notification Letter (Spanish)  June 2020
  • Carta de notificación para el padre/tutor  June 2020
• Sample Parent/Guardian Notification Letters for Direct Certification
  • Version 1: SNAP, TFA, Medicaid (English)  June 2020
  • Version 1: SNAP, TFA, Medicaid (Spanish)  June 2020
    • 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  June 2020
  • Version 2: Foster Child, Homeless, Runaway, Head Start (English)  June 2020
  • Version 2: Foster Child, Homeless, Runaway, Head Start (Spanish)  June 2020
    • 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  June 2020
  • Version 3: Medicaid Benefits Reduced-price Meals (English)  June 2020
  • Version 3: Medicaid Benefits Reduced-price Meals (Spanish)  June 2020
    • 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  June 2020

H

Healthy Food Certification (HFC)

• HFC Documentation Form 1: Purchased Foods and Beverages Sold in Cafeteria  September 2020
• HFC Documentation Form 2: School-made Foods Sold in Cafeteria  September 2019
• HFC Documentation Form 3: Foods and Beverages Sold in Vending Machines  September 2019
• HFC Documentation Form 4: Foods and Beverages Sold in School Stores  September 2019
• HFC Documentation Form 5: Food and Beverage Fundraisers  September 2019
• HFC Documentation Form 6: Foods and Beverages Sold from Other Sources  September 2019
• HFC Documentation Form 7: School-made Foods Sold from Other Sources  September 2019
• Sample Fundraiser Form for HFC  January 2019

I

Interschool Agreements

• Full-service Interschool Agreement Form  January 2020
• Recipient Site Vended Interschool Agreement  January 2020

M

Meal Counting and Claiming

• Meal Application and Data Management Process Form  August 2019
• Site Information on Money Collection and Point-of-Service (POS) Meal Count Systems Form  August 2019

Media Release (see Public Media Release)

Medical Statement

• Medical Statement for Meal Modifications in School Nutrition Programs (English) July 2019
• Medical Statement for Meal Modifications in School Nutrition Programs (Spanish)  August 2019
  • Declaración médica para la modificación de alimentos en los programas de nutrición escolar  agosto 2019
• Guidance and Instructions: Medical Statement for Meal Modifications in School Nutrition Programs (English)  July 2019
• Guidance and Instructions: Medical Statement for Meal Modifications in School Nutrition Programs (Spanish)  August 2019
  • 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  September 2019
• Breakfast Five-day Menu Planning Form for Ages 3-4  September 2019
• Breakfast Four-day Menu Planning Form for Ages 1-2  September 2019
• Breakfast Four-day Menu Planning Form for Ages 3-4  September 2019
• Breakfast Seven-day Menu Planning Form for Ages 1-2  September 2019
• Breakfast Seven-day Menu Planning Form for Ages 3-4  September 2019
• Lunch Five-day Menu Planning Form for Ages 1-2  September 2019
• Lunch Five-day Menu Planning Form for Ages 3-4  September 2019
• Lunch Four-day Menu Planning Form for Ages 1-2  September 2019
• Lunch Four-day Menu Planning Form for Ages 3-4  September 2019
• Lunch Seven-day Menu Planning Form for Ages 1-2  September 2019
• Lunch Seven-day Menu Planning Form for Ages 3-4  September 2019

Menu Planning Checklist for Lunch for Grades K-12

• Five-day Week Lunch Menu Planning Checklist: Grades K-5  July 2019
• Five-day Week Lunch Menu Planning Checklist: Grades 6-8  July 2019
• Five-day Week Lunch Menu Planning Checklist: Grades 9-12  July 2019
• Five-day Week Lunch Menu Planning Checklist:Grades K-8  July 2019
• Seven-day Week Lunch Menu Planning Checklist:Grades 6-8  July 2019
• Seven-day Week Lunch Menu Planning Checklist: Grades K-5  July 2019
• Seven-day Week Lunch Menu Planning Checklist: Grades 9-12  July 2019 
• Seven-day Week Lunch Menu Planning Checklist: Grades K-8  July 2019

Monitoring Forms

• On-site School Review Checklist for the NSLP  August 2019
• On-site School Review Checklist for the SBP  August 2019
• Overview of Meal Counting and Claiming Process  August 2019

Nonprogram Foods

• Nonprogram Pricing Worksheet: Adult Meals  August 2019
• Nonprogram Pricing Worksheet: A La Carte Sales  August 2019
• Nonprogram Revenue Calculator (USDA)  February 2019
• Nonprogram Revenue Tool for Five-day Reference Period (Kansas Department of Education)  2018

P

Paid Lunch Equity

• Paid Lunch Equity Calculations and Tool 2020-21 (USDA) March 2020
• Paid Lunch Equity Guidance: USDA Memo SP 07-2020: Paid Lunch Equity: Guidance for School Year 2020-21 January 2020

Policy Statement

• Policy Statement for Free and Reduced-price Meals, Afterschool Snack Programs, and Free Milk  June 2020

Procurement

• Buy American Justification Form  August 2019
• Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion – Lower Tier Covered Transactions  September 2019
• Sample Code of Conduct for Procurement  September 2019
• Sample Procurement Procedures for School Food Authorities (Version 1)  September 2019
• Sample Procurement Procedures for School Food Authorities (Version 2)  September 2019

Production Records

Food Components Lunch or Breakfast

• Production Record for Grades K-5 in the NSLP or SBP  January 2020
• Production Record for Grades 6-8 in the NSLP or SBP  January 2020
• Production Record for Grades 9-12 in the NSLP or SBP  January 2020
• Production Record for Grades K-8 in the NSLP or SBP  (Legal size)  January 2020
• Production Record for Grades K-12 in the NSLP or SBP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-8 in the NSLP or SBP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-12 in the NSLP or SBP  (Legal size)  January 2020
• Production Record for Ages 1-4 (Preschool) in the NSLP or SBP  January 2020
• Production Record for Ages 3-4 (Preschool) in the NSLP or SBP  January 2020

Food Items Lunch

• Production Record for Grades K-5 in the NSLP  January 2020
• Production Record for Grades 6-8 in the NSLP  January 2020
• Production Record for Grades 9-12 in the NSLP  January 2020
• Production Record for Grades K-8 in the NSLP  (Legal size)  January 2020
• Production Record for Grades K-12 in the NSLP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-8 in the NSLP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-12 in the NSLP  (Legal size)  January 2020
• Production Record for Ages 1-4 (Preschool) in the NSLP  January 2020
• Production Record for Ages 3-4 (Preschool) in the NSLP  January 2020

Food Items Breakfast

• Production Record for Grades K-5 in the SBP  January 2020
• Production Record for Grades 6-8 in the SBP  January 2020
• Production Record for Grades 9-12 in the SBP  January 2020
• Production Record for Grades K-8 in the SBP  (Legal size)  January 2020
• Production Record for Grades K-12 in the SBP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-8 in the SBP  (Legal size)  January 2020
• Production Record for Preschool (Ages 3-4) and Grades K-12 in the SBP  (Legal size)  January 20200
• Production Record for Ages 1-4 (Preschool) in the SBP  January 2020
• Production Record for Ages 3-4 (Preschool) in the SBP  January 2020

Professional Standards

• Professional Standards Tracking Log  January 2020

Public Media Release

• Sample Public Media Release for Connecticut School Nutrition Programs  June 2020

S

Seamless Summer Option (SSO)

• SSO Daily Meal Count  April 2019
• SSO Weekly Meal Count Consolidation  April 2019

Special Milk Program

• SMP Daily Milk Count Form (EXCEL)  August 2019
• SMP Daily Milk Count Form (PDF)  August 2019
• SMP Daily Milk Count Form Instructions  August 2019
• Sample Completed SMP Daily Milk Count Form  August 2019

Standardized Recipes

• Standardized Recipe Form for School Nutrition Programs  June 2020

U

USDA Foods

• USDA Foods Transfer Request Form  August 2019
• Worksheet for Calculating Direct Delivery of USDA Foods (Brown Box)  February 2019
• Worksheet for Calculating Processed USDA Foods  February 2019

V

Verification

• Letter of Verification Results and Adverse Action for Income Households (English)  August 2019
• Letter of Verification Results and Adverse Action for Income Households (Spanish)  August 2019      
  • Ejemplo de carta de resultados de verificación y medida adversa para grupos familiares con ingresos  agosto 2019
• Household Letter to Verify Eligibility (English)  August 2019
• Household Letter to Verify Eligibility (Spanish)  August 2019
  • Ejemplo de carta para el grupo familiar a fin de verificar la elegibilidad de la familia  agosto 2019
• Household Letter: Second Notification to Verify Eligibility (English)  August 2019
• Household Letter: Second Notification to Verify Eligibility (Spanish)  August 2019
  • Ejemplo de carta para el hogar de segundo aviso para verificar la elegibilidad familiar  agosto 2019
• Household Employer Letter (English)  August 2019
• Household Employer Letter (Spanish)  August 2019
  • Ejemplo de carta de empleador de grupo familiar
• Household Letter for Social Security Office (English)  August 2019
• Household Letter for Social Security Office (Spanish)  August 2019
  • Ejemplo de carta para grupo familiar de la Oficina del Seguro Social  agosto 2019
• Optional Household Letter: Notification of Continuation of Benefits as a Result of Verification (English)  August 2019
• Optional Household Letter: Notification of Continuation of Benefits as a Result of Verification (Spanish)  August 2019
  • Ejemplo de carta opcional para el grupo familiar: Notificación de continuación de beneficios como consecuencia de la verificación  agosto 2019
• Sample Verification Selection Worksheet  August 2019

Y 

Yield Study

• Yield Study Form for Child Nutrition Programs (CSDE)  June 2020