• Parent/Guardian Request for Fluid Milk Substitution

    Lee County Schools Child Nutrition Program

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    Parents/guardians may request, in writing, a non-dairy fluid milk substitution for their child with a medical or special dietary need without providing a statement from a medical authority. The milk substitute requested must be nutritionally equivalent to fluid milk and meet the nutritional standards set by the United States Department of Agriculture (USDA) for Child Nutrition Programs1.

     

    A non-dairy milk substitute must, at a minimum, contain the following nutrient levels per cup (8 fluid ounces) to qualify as an acceptable milk substitution:

    Nutrient

    Amount

    Nutrient

    Amount

    Protein

    8 grams

    Phosphorus

    222 mg

    Calcium

    276 mg

    Potassium

    349 mg

    Vitamin A

    500 IU

    Riboflavin

    .44 mg

    Vitamin D

    100 IU

    Vitamin B-12

    1.1 mcg

    Magnesium

    24 mg

     

     

    1Reference: 7 CFR 210.10(d)(3) and 7 CFR 220.8(d); 2Reference: USDA Policy Memo SP 35-2009 Q&As: Milk Substitution for Children with Medical or Special Dietary Needs (Non-Disability)

     

    To comply with federal regulations Lee County Schools Child Nutrition provides lactose free milk or soy milk for all students with milk intolerance or sensitivity. Both products meet the nutrition standards set by USDA for Child Nutrition Programs. Fruit juice and water do not qualify as milk substitutes and cannot be served as a milk substitution. However all students can decline milk and have access to water. Cups for water are available at no cost.

     

    To be completed by Parent/Guardian and returned to Child Nutrition Office:

    Student’s name:

     

    School:

     

    Grade:

    State the medical or dietary need that restricts the student’s diet and requires a substitute for fluid milk:

     

     

    Milk substitute options, please select one that best fits your child's needs. If you need assistants please contact the school nurse or child's physician or call Child Nutrition Office at 919-774-6226.

     

    Lactose Free Milk             Soy Milk

     

    Parent Signature:

     

    Date:

    Please return this form to:  

    Lee County Schools Child Nutrition Program

    Attn: Amanda Cagle, Child Nutrition Director

    PO Box 1010

    106 Gordon Street

    Sanford, NC 27331-1010

    acagle@lee.k12.nc.us     919-774-6226

     

    OFFICE USE ONLY

     

    Milk substitute provided? lactose free or soy

     

    Date:

    This written statement will remain in effect until the parent or legal guardian revokes such statement or until the school discontinues the fluid milk substitution option.

     

     

     

    In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

     

    Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

     

    To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

    (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

    (2) fax: (202) 690-7442; or

    (3) email: program.intake@usda.gov.

     

    This institution is an equal opportunity provider.