Special Dietary Requests

Special Dietary Needs

According to the National School Lunch Program Act, we are required to adhere to specific Federal regulations in accommodating students with a disability only if the disability prevents the child from eating the regular school meal, the school will make modifications or substitutes only prescribed by a Licensed Physician.

Once a child has been diagnosed with a food allergies or intolerances a Special Diet Statement form must be filled out by a Licensed Medical Physician and is only for a participant with a disability that affects the diet. 

This form must be:
    • Completed and signed by a Licensed Medical Physician (M.D. or D.O.).
    • Submitted to  Food & Nutrition Director before any meal modifications 
will be made in the USDA Child Nutrition Programs.
  • Updated each time a participant’s diagnosis or special diet changes.

Special Diet Statement forms can be found through the link below or by contacting the Food & Nutrition Director at (507) 356-4849 

Lactose-Free Milk Requests

Pine Island Public Schools will provide lactose-free milk for children with lactose intolerance at no charge with a meal.  Students may purchase lactose-free milk a la carte or for milk break for an additional fee.  Parents can request lactose-free milk for their student by filling out a Request for Lactose – Free Milk form. Please note that this request must be kept current and submitted yearly.  

Pine Islands Lactose-Free Milk option is “Lactaid”. Any other milk substitution requests will need to be accompanied by completing the “Special Diet Statement” link below.


Special Diet Statement Form 

Request for Lactose-Free Milk