Medical Statement to Request Dietary Accommodations

Students with special dietary needs should submit a Medical Statement to Request Dietary Accommodations to their school’s nurse each school year. The request must be signed by both a licensed medial provider and a parent/legal guardian. This form should only be used for dietary accommodations for medical reasons. Food preferences are not an appropriate use of this form and will not be accommodated. For student’s that do not have a disability, DCPS may, but is not required to make food substitutions. Any incomplete or incorrect forms will be returned for completion.

Fluid Milk Substitutions 

Students who need to request a fluid milk substitute due to a medical or special dietary need should complete a Fluid Milk Substitution Request Form. This information should be completed each school year and turned into the school nurse. A parent/legal guardian signature is required for this form. Please note that milk substitutes must meet the nutrition regulations determined by USDA. Juice and/or water cannot be offered as a fluid milk substitute for students with medical or special dietary needs that do not rise to the level of a disability. Any incomplete or incorrect forms will be returned for completion.

Students with Philosophical or Religious Dietary Needs

Students may request a food substitution based on religious or philosophical beliefs through the Students with Philosophical or Religious Dietary Needs Form. This information should be completed each school year and turned into the school nurse. A parent/legal guardian signature is required for this form. Vegetarian options are always available for lunch K-12, if you would like to ensure vegetarian options for breakfast, classroom meals, or afterschool snack or supper parents/guardians are encouraged to complete a Students with Philosophical or Religious Dietary Needs Form. This form is not intended to accommodate student taste preferences. It is up to the discretion of DCPS as to whether they are able to accommodate students’ requests made using this form. Any incomplete or incorrect forms will be returned for completion.

Important things to note for all dietary accommodations forms:

• Forms must be complete before accommodations can be met; including parent/legal guardian signatures and licensed medical provider signatures.
• Because dietary needs change over time, forms must be completed and turned into the school nurse each school year.
• It is the responsibility of the parent/legal guardian to provide current medical and/or nutritional needs of the student, submitting new forms as needed.
• Dietary accommodations are tracked at the school level. If your student transfers to another DCPS school, the form must be resubmitted with updated school information included.
• Parents/Legal Guardians are encouraged to keep a copy of the form that they turn into the school nurse in case follow-up conversation is needed.
• It can take 3-4 weeks from the time forms are received by Food and Nutrition Services from the school nurse for dietary accommodations to be made in the cafeteria. Please be sure to prepare for other accommodations during this time.
• All school meals provided by FNS are tree nut and peanut free and pork is not served in elementary schools or education campuses.

If you have any questions regarding the dietary accommodations process, please contact Food and Nutrition Services at [email protected] or (202) 299-2159.