Irving ISD - Food & Nutrition Services

Special Diets Request Form

Thank you for taking the time to help us serve you. Our Registered Dietitian, Dawn Lin, will be happy to work with you to ensure that your child’s nutritional needs are met. Please complete the Special Diet form on this page to get the process started. A representative may contact you if we need further clarification or instructions.

This form must be used for students who require special diets due to disabilities, and should be updated whenever necessary (at least at the start of each school year). A medical doctor or other authorized, recognized medical authority must complete the applicable areas.

Forms UPDATED June 27, 2012

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Special Diet Forms (1)

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Name ▲			Size	Date
	2012-2013_Special_Diet_Request_Form.pdf		393.90 Kb	06/27/12

For questions or comments contact:

Dawn Lin, Registered Dietitian
dlin@irvingisd.net
Office 972-600-6918
Fax 972-273-6906

DISCLAIMER OF EXPRESSED OR IMPLIED WARRANTIES

The Irving Independent School District (“IISD”) has made no affirmation of fact or promise relating to any special diet plan or the special diet itself that is being sold, furnished, or delivered to any recipient of the same. Further, IISD has made no affirmation of fact or promise relating to the special diet that has created or amounted to an express or implied warranty that the special diet would conform to any such affirmation or promise.

DISCLAIMER OF IMPLIED WARRANT OF FITNESS

THE IISD DISCLAIMS ANY WARRANTY OF FITNESS FOR ANY PARTICULAR PURPOSES WHATSOEVER WITH RESPECT TO THE SPECIAL DIET BEING SOLD OR DELIVERED.

DISCLAIMER OF IMPLIED WARRANTIES

THE FOOD AND DRINKS DESCRIBED IN AND SPECIAL DIET PLAN ARE SOLD, FURNISHED OR DELIVERED “AS IS” OR “WITH ALL FAULTS”, AND IISD DISCLAIMS ANY IMPLIED WARRANTIES WITH RESPECT TO THE SPECIAL DIET AND RELATED FOOD OR DRINK PRODUCTS.

USDA Non-Discrimination Statement (NDS)

In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability.

To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.

De acuerdo con la ley federal y las políticas del Departamento de Agricultura de los EE.UU. (USDA, sigla en inglés), se le prohíbe a esta institución que discrimine por razón de raza, color, origen, sexo, edad, o discapacidad.

Para presentar una queja sobre discriminación, escriba a USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410, o llame gratis al (866) 632-9992 (voz). Personas con discapacidad auditiva o del habla pueden contactar con USDA por medio del Servicio Federal de Relevo (Federal Relay Service) al (800) 845-6136 (español) o (800) 877-8339 (inglés). USDA es un proveedor y empleador que ofrece oportunidad igual para todos.