Food & Nutrition Services » Special Dietary Needs Form

Special Dietary Needs Form

Accommodating Students with Disabling Special Dietary Needs

Schools participating in a federal Child Nutrition Program (School Lunch, School Breakfast or After School Snack Program) are required to make accommodations for children who are unable to eat the school meals because of a disability* that restricts their diet.  In order to make modifications or substitutions to the school meal, schools must have a written Medical Statement on file that is signed by a licensed physician.  The statement must identify:

  • The child’s disability
  • An explanation of why the disability restricts the child’s diet
  • The major life activity affected by the disability
  • The food(s) to be omitted from the child’s diet
  • The food or choice of foods that must be provided as the substitute


*Only a physician can declare if a student has a disability.

Accommodating Students with Non-Disabling Special Dietary Needs

Schools may, at their discretion, make substitutions for students who have a special dietary need, but do not meet the definition of disability.  Examples include food intolerances or allergies that do not cause life-threatening reactions.  The decision to accommodate a student’s special dietary need can be determined on a case-by-case basis, however, the school should remain consistent with accommodating special dietary needs.  In order to make modifications or substitutions to the school meal, schools must have a written Medical Statement signed by a recognized medical authority identifying the following:

  • An identification of the medical or other special dietary condition which restricts the child’s diet
  • The food or foods to be omitted from the child’s diet
  • The food or choice of foods to be substituted


In Pennsylvania, a recognized medical authority includes a physician, physician assistant, and nurse practitioner.

Milk Substitutions for Students with Non-Disabling Special Dietary Needs

For students with non-disabling special dietary needs which restrict their intake of fluid milk, the following applies.

  • A recognized medical authority (physician, physician assistant, or nurse practitioner) may request a fluid milk substitute for a student with a non-disabling medical dietary need, such as milk intolerance, or due to cultural, religious or ethnic beliefs.  The request must be made in writing.
  • The written request from a medical authority must identify the student’s medical or special dietary need that prevents them from consuming cow’s milk.  Specifically referring to milk substitutions, a “special dietary need” can refer to cultural, ethnic, or religious needs, as well as medical needs.
  • Nondairy beverages offered as a fluid milk substitute must meet the established nutrient standards.
  • Juice and water cannot be substituted for fluid milk as part of the reimbursable meal even when requested by a physician.  When fruit juice is merchandised as an option for a fruit/vegetable component, it can contribute up to 3/8 cup of the fruit/vegetable component.  It cannot be offered in place of milk and it must be available to all students as an option. 


Responsibility of Parents

  • Notify the school of any food allergy, disability or special dietary need.
  • Provide Medical Statement completed by a physician (disability), a recognized medical authority (non-disabling special dietary need), or the parent (non-disabling special dietary needs for milk only).
  • Participate in any meetings or discussions regarding the student’s meal plan.  Maintain a healthy line of communication with the school.
  • Notify the school of any changes relating to the special dietary need (a new Medical Statement is required if the diet changes).