Diet Modification & Student Food Allergy Information

If your child has a disability or life-threatening food allergy and you would like a substituted menu, you will need to obtain a Disability/Medical Condition Statement for Foods Served by calling the Nurse of the school your child attends or the Nutrition Services Department at 319-228-8701 ext 119, or print off the form below. This form will need to be signed by a physician licensed by the State and returned to the nurse where your student attends. Requests for special diets must be submitted annually and updated by a physician annually.


The State of Iowa requires the Diet Modification Request Form on file with the nutrition department. This form must be completed and signed by student’s parent and Physician. The Diet Modification Request form provides the district with detailed information regarding foods to avoid and foods to substitute to accommodate the food allergy.
Once the nutrition department receives the Diet Modification Request form we will confirm receipt and communicate any additional steps that may be needed.

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