Forms for Child Nutrition Programs

Afterschool Snack Program

Afterschool Snack Schedule B SY12/13 (.doc)

Afterschool Snack Schedule B SY 13/14 (fillable pdf)

Afterschool Snack Program Review Form / On-Site Review Form (.doc) 

 Free and Reduced Price Meals 2012-2013 (DO NOT USE UNTIL AFTER JULY 1, 2012)

         Forms Packet 06.21.12

Forms Packet 04.30.13 .pdf

Forms Packet 04.30.13 .doc

Eligibility Guidelines 2012-13

Eligibility Guidelines 2013-14

Application Packet 2012-13.doc

Spanish Packet 06.21.12

Spanish Packet 04-30-13 (doc)

Spanish Packet 04-30-13 (pdf)

Healthy Schools

Committee Reporting Form for Nutrition and Physical Activity or Wellness Committee (.pdf)

Health Inspection Form 12/13

Wellness Policy Checklist Attachment
Wellness Committee Form
Cycle 2 - October 1 Enrollment and Eligibles

Students Report - 2012/2013 (.pdf)

Program Management

Menu Planning Tool (Lunch Menu Planning Tool beginning SY 2012-2013) – Developed by the Iowa Department of Education, Nutrition Services
Blank Recipe Form

Production Records
Meals Per Labor Hour Worksheet (.xls)
- Sample Staffing Guidelines using Meals per Labor Hour (.pdf) (from Iowa Dept. of Ed. 9/27/06)
Documentation of Child Nutrition Training for Staff SY10/11
Training Hours (no watermark)
On-Site Review Form (.xls) (Revised 2011)
Coordinated Review Effort (CRE) Self Review Form (.doc)

Eligibility Master Roster for Over 1,000 Students (xls)
Eligibility Master Roster for Less than 1,000 Students (xls)
Certification of Disability for Special Dietary Needs Form (.pdf)

Time Certification Form - 100% Child Nutrition (.doc)
Time Certification Form - Less Than 100% Child Nutrition (.xls)
Bid Tabulation Form - August 2009 (.xls)

Reimbursement

Claim for Reimbursement 2012-2013 (xls)  - Instructions for Claim Form 2012-2013 (doc)
Cash Management Worksheet (.xls)
Daily Record Form (.xls)
Edit Check Worksheet (.doc)

Safety Net Listing 2012-2013

FFVP Claim for Reimbursement (Excel) 2012-13 (SY 2012-2013 ONLY for those schools approved to participate in the FFVP) NOTE: Claim updated 06/12

Instructions for 2012-2013 FFVP Claim for Reimbursement (.doc) - NOTE:  This form was updated 6/12.

Summer Meals Program

Seamless Summer Schedule C-14 SY 13/14 (doc)

Seamless Summer Schedule C-14 SY 13/14 (pdf)

Seamless Summer Schedule C-13 SY12/13 (doc)

Seamless Summer Schedule C-13 SY12/13 (pdf)

Verification Reporting

Application and Verification Forms / Letters Packet - 2012-2013 (.doc)
Verification Summary Report (.xls) 2012-2013