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ADVANCE NOTICE REQUIRED
Must be requested by Monday for the following week (e.g., Mon Sept 8 for the week of Sept 15)

This form may be used to request a plant-based lunch for a child with a preference that restricts their diet.
Please note, this form should not be used to request meal modifications related to a disability (i.e., a physical or mental impairment that substantially limits one or more major life activities).

This form may be used to request a meal modification for a child with a physical or mental impairment that restricts their diet.
Portions of this form must be completed by a State Licensed Healthcare Professional (who is authorized to write medical prescriptions under Illinois law) or a Registered Dietitian.