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Education Benefit Application – Burlington-Edison School District #100
CONSENT TO SHARE PROGRAM ELIGIBILITY INFORMATION FOR OTHER SCHOOL PROGRAMS
CONSENTIMIENTO PARA COMPARTIR INFORMACIÓN DE ELEGIBILIDAD DEL PROGRAMA PARA OTROS PROGRAMAS ESCOLARES
It is the goal of the Burlington Edison Child Nutrition Department to provide meals that meet the health and nutritional needs of our students. Students are offered a variety of appealing food choices daily and can make selections that meet the following program requirements:
Breakfast Meal Requirements
½ pint of Low Fat Milk
½ cup Juice, Fruit or Vegetable
2 oz. of Grain or 2 oz. of Protein or a combination of 1 oz. each.
Lunch Meal Requirements½ pint of Low Fat Milk¾ cup Fruit/Vegetable
8 servings of Grain / Week
2 oz. serving of Protein
Nondiscrimination Statement
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:
mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; orfax:
(833) 256-1665 or (202) 690-7442; oremail:
Program.Intake@usda.gov
This institution is an equal opportunity provider.