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Meal Modifications Information Form for the School Meals Program
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Email
*
Record my email address with my response
Your Full Name (person filling out the form)
*
Your answer
Students Full Name
*
Your answer
Student ID #
Your answer
Phone number to contact if there is any questions
*
Your answer
Does the student have a food allergy?
*
Yes
No
Please list food allergies or modification requests
Your answer
Other Comments
Your answer
A copy of your responses will be emailed to .
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