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Special Diet Form
little children Accommodating Children with Special Dietary Needs
The School Nutrition Program accommodates children with special dietary needs if a Medical Statement form is submitted. The Medical Statement form must be completed and signed by a licensed Physician or Medical Authority.
If the child’s diet changes during the school year a new Medical Statement must be submitted.
The original Medical Statement is kept on file in the School Nutrition Department. A copy of the statement is kept on file with the School Cafeteria Manager and the School Nurse. Menu changes are made through the School Nutrition Department and are communicated to the School Cafeteria Manager and School Nurse (if requested).
Download the Medical Statement English or pick up a copy at the school.

Please contact the School Nutrition Department for assistance: 
828.255.5932 phone
828.255.5899 fax

Medical Statement for Students with Special Nutritional Needs for School Meals

When completed fully, this form gives schools the information required by the U.S. Department of Agriculture (USDA), U.S. Office for Civil Rights (OCR), and U.S. Office of Special Education and Rehabilitative Services (OSERS)  for meal modifications at school. See “Guidance for Completing Medical Statement for Students with Special Nutritional Needs for School Meals” for help in completing this form.

Medical Statement (English) 58 KB (Updated: May, 2022)
Medical Statement (Spanish) 89 KB (Updated: May, 2022)
Fluid Milk Substitution Form 100 KB (Updated: March 10, 2021)

This institution is an equal opportunity provider.

Buncombe County Schools is in the process of reviewing its website to ensure compliance with Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. Buncombe County Schools does not discriminate on the basis of sex in its education programs or activities and is required by Title IX of the Education Amendments Act of 1972 and federal regulations to not discriminate in such a manner. This requirement extends to admission and employment. Inquiries about the application of Title IX and its implementing federal regulations may be referred to the Title IX Coordinator and/or the Assistant Secretary for Civil Rights in the Office for Civil Rights at the U.S. Department of Education. The Title IX Coordinator's contact information is: Shanon Martin, [email protected], 828-255-5918, 175 Bingham Road, Asheville, NC 28806.

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