School Lunch Reimbursement Rate Request Form
Submit your request for a determination or update of your school lunch reimbursement rate. Please provide all required details for prompt review.
Requester full name
*
First Name
Last Name
Requester email address
*
example@example.com
Organization or district name
*
School or site name
*
School year or effective date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Lunch program participation
*
National School Lunch Program (NSLP)
Seamless Summer Option (SSO)
Other
Enrollment (number of students)
*
Average daily lunches served
*
Current reimbursement rate (per lunch, if applicable)
Reason for request and supporting notes
*
Submit Request
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