Johnny Key

Commissioner of Education

Read Bio  

Forms

Afterschool Snack Program

Afterschool Snack Program Review From/On-Site Review Form (PDF)

Agreement and Policy Statement Renewal 2017-18 

Instructions on How to Complete Renewal Agreement Packet (PDF)

Renewal Agreement Checklist (PDF fillable)

Renewal of Agreement (PDF fillable)

Menu Planning Attestation (PDF fillable)

Meal Patterns (PDF) - do not return to CNU

Health Inspection Report for 2016-2017 School Year (PDF fillable)

Wellness Attestation (PDF fillable)

Civil Rights Assurances Attestation (PDF fillable)

Attestation Statements Paid Lunch Equity, Claims, Professional Standards (PDF fillable)

Renewal of Policy Statement (PDF fillable)

Meal Count and Collection Procedures (PDF fillable)

Free and Reduced Price Materials Attestation (PDF fillable)

Application Materials RequirementChecklist (PDF) - do not return to CNU

Distribution of Application Materials Checklist (PDF fillable)

Child Nutrition Contact and Appeals Hearing Attestation (PDF fillable)

Prototype Letter to Household Frequently Asked Questions (Word) - do not return to CNU

Prototype Instructions on How to Apply (Word) - do not return to CNU

Prototype Free and Reduced Price Meal Application (Publisher) - do not return to CNU

Prototype Free and Reduced Price Materials forms and letters (Word) - do not return to CNU

Public Release (Word) - do not return to CNU

Income Eligibility Guidelines for 2017-18 School Year (PDF) - do not return to CNU

Safety Net School Districts 2017-18 School Year (PDF) - do not return to CNU

Schedule A Blank (PDF fillable) only return if new school(s)

Schedule B Afterschool Snack (PDF fillable) - only return if SFA is serving Afterschool Snacks

Schedule C-18 Seamless Summer Option Summer 2018 (PDF fillable) - only return if SFA is serving Seamless Summer in summer of 2018

 

The USDA Translated Applications website includes translation resources available for use by School Districts.

The Spanish language application and letters are included on this USDA website.

Translations for applications intended to be used directly by SFAs to distribute to families:

·        http://www.fns.usda.gov/school-meals/translated-applications

 

Public Release 2017-18 for Special Provision Schools:

Community Eligibility Provision Public Release (Word)

Provision 2 Base Year Public Release (Word)

Provision 2 Non-Base Year Public Release (Word

Fruit and Vegetable Program

  • FFVP Claim for Reimbursement 2017-18 (8/2017) (EXCEL)
  • Instructions for 2017-18 FFVP Claim for Reimbursement (8/2017) (DOC)
  • 2017-18 Equipment Request Form (DOC)
  • Fax Cover Sheet (DOC)
  • FFVP On-Site Review Form (EXCEL)
  • Hourly Pay Rate Form (PDF)
  • Monthly Time Sheet (EXCEL)

Healthy Schools / Wellness Policy

  • Wellness Committee Requirements Checklist - Part 1 and 2 of Triennial Assessment (DOC)

Labor Evaluation

  • Meals Per Labor Hour Worksheet SY 2017-18 (9/2017) (EXCEL)
  • Sample Staffing Guidelines using Meals per Labor Hour from Iowa Dept. of Ed. 9/27/06) (PDF)

Procurement

  • Buy American Justification Form (WORD)
  • Bid Tabulation Form – (8/2009) (EXCEL)

Program Management

  • Food Donation Documentation (PDF)
  • How You Can Help Prevent Wasted Food (PDF)
  • 2017-18 Paid Lunch Equity Tool (EXCEL)
  • Lunch Menu Planning Tool (beginning SY 12-13) – Developed by the Iowa Department of Education, Nutrition Services) (EXCEL)
  • Master Roster Less than 1000 Students (XLS)
  • Master Roster More than 1000 Students (XLS)
  • Recipe Form (PDF)
  • Recipe Analysis Worksheet (XLS)
  • Lunch Production Record - with Temperature Control Record Instructions (EXCEL)
  • Lunch Production Record - K-08 (EXCEL)
  • Lunch Production Record - 09-12 (EXCEL)
  • Lunch Production Record Instructions (PDF)
  • Daily Breakfast Production Record - with Temperature Control Record (8/2014) (PDF)
  • Weekly Afterschool Snack Production Record  - with Temperature Control Record (PDF)
  • On Site Review (2017) (PDF)
  • Afterschool Snack Program On-Site Review Form (PDF)

Reimbursement

  • Flowchart for Original Claim Submission (PDF)
  • Flowchart for Claim Revision Processing (PDF)
  • Claim Revision Request Form (PDF)
  • Aid for Efficient On-Line Claim Preparation (EXCEL)
  • Instruction for Aid for Efficient On-Line Claim Preparation (PDF)
  • Cash Management Worksheet (EXCEL)
  • Daily Record Form (EXCEL)
  • Edit Check 2 Worksheet (PDF)

Meal Modifications (previously Special Dietary Needs)

Staff Training

  • Documentation of Child Nutrition Training for Staff – Sign In Sheet (PDF)
  • Consolidation of Training Hours (PDF)

Summer Meals Program

Time Certification

  • Time Certification Form - 100% Child Nutrition (PDF)
  • Time Certification Form - Less Than 100% Child Nutrition (EXCEL)

Verification Reporting

  • FNS-742-SFA Verification Collection Report (EXCEL)
  • Standard Sample Verification List 2017-18 (EXCEL)

State Standards

Learn more about the standards that define the knowledge and skills Arkansas students should have in order to be ready for college and careers.

Learn More

Licensure & Certification

Find critical information about renewing Arkansas educator licenses, adding areas of licensure, licensing by reciprocity from other states, background checks and more.

Learn More

ESEA Flexibility

Learn More

Latest News & Events

Learn More