Sponsor Number Sponsor Name

USDA Memo SP 32-2017 allows Sponsors the ability to request an exemption allowing service of low-fat (1%) flavored milk in the National School Lunch Program, School Breakfast Program and as a competitive food available for sale on campus during the school day. In order to qualify for the exemption, schools must demonstrate hardship by documenting a reduction in student milk consumption or an increase in school milk waste. Approvals are valid for SY 2017-18.

Parts 1-3 must be completed in their entirety. Any incomplete exemption request forms will not be approved and will be returned to the Sponsor.

Part 1: Sponsor Information

Sponsor Number Sponsor Name

Exemption being requested for (check all that apply)
School Breakfast Program National School Lunch Program Competitive food

Part 2: Documentation of Hardship

Reasons for requesting exemption. Attach supporting documentation (records, photos, survey results, etc.)
(check all that apply)
Significant decrease in milk sales since implementation of the current meal patterns
Declining milk sales despite offering alternative products and brands
Food waste study indicated significant waste of fluid milk
Significant negative feedback from students and parents regarding lack of availability of low-fat, flavored milk
Significant negative feedback from students regarding palatability of fat-free, flavored milk
Other:

Part 3: Signatures

______

Authorized Representative Signature Email Date

Food Service Director Signature Email Date

Email request form and supporting documentation to Kelly Chanay at

KSDE CNW USE ONLY
Request has been Approved Denied
Comments:
Reviewed By: / Date:

Child Nutrition & Wellness, Kansas State Department of Education Page 2