Food Allergies/Special Dietary Needs

Dietary Modification Medical Statement Form

July 2021

Guidelines for Accommodating Children with Special Dietary Needs

Schools participating in a federal school meal program, such as the National School Lunch Program, and School Breakfast Program, are required to make reasonable accommodations for children who are unable to eat school meals because of disabilities that restricts their diet. Schools will provide modifications for children on a case-by-case basis when requests are accompanied by a written statement from a licensed healthcare professional, such as a licensed physician, physician’s assistant, or nurse practitioner. In order to ensure the provision of appropriate and safe meals, the healthcare professional must submit this information using the school division’s Dietary Modification Medical Statement Form

The completed Medical Statement Form must be returned to either the school nurse or faxed directly to the Supervisor of School Nutrition at 434-432-2487. Upon receipt of the form, the Supervisor of School Nutrition will then contact the parent/guardian to discuss the options available for accommodating the child’s need and will provide the date at which the cafeteria can begin the child’s special diet. Planning for meal modifications and training staff requires time; therefore, there may be a few days until the cafeteria has the special menu in place for the student. Until the special meal has been developed foods provided by the parent or guardian would be the safest option. 

Other dietary requests, including those related to general health concerns, personal preferences, and moral or religious reasons are not disabilities and are optional for schools to accommodate. Most of these needs can be met within the general meal plan since a variety of choices are offered to students daily.

For more information about requesting special meal modifications for students with disabilities, please contact the Supervisor of School Nutrition, Kara Scott at 434-432-2761 ext. 5045 or through email at