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Wisconsin Department of Public Instruction
SCHOOL FOOD AUTHORITY—CIVIL RIGHTS COMPLIANCE
Self Evaluation—National School Lunch Program (NSLP)
PI-1441 (Rev. 09-15)
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U.S. Department of Agriculture regulations outline the responsibility of each School Food Authority (SFA) in regard to Civil Rights Compliance. The following self-evaluation provides an overview of requirements to assist the SFA in determining Civil Rights status. (USDA) FNS Instruction 113-1. Complete by October 31 annually.
Keep on file. Do not send to the DPI.
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GENERAL INFORMATION
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Name of School Food Authority (SFA)
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Date Mo/Day/Yr
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Agreement Number/Agency Code
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Yes
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No
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NA
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1. Does the public release about the NSLP (National School Lunch Program) include:
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a. the required nondiscrimination statement?
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b. complaint filing information?
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2. Has the public release about the NSLP been sent to news media and community/grassroots organizations?
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3. Has a procedure for handling discrimination complaints/grievances been established?
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4. Have any complaints of discrimination (written or verbal) been received in the past three years?
If Yes, indicate the disposition of each case (attach sheet).
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5. Is the nondiscrimination and “And Justice for All” poster displayed in a prominent place, visible to and readable by recipients, near the serving area?
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6. Is there a need for program materials to be printed in a language other than English?
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If Yes, has this been done?
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7. Complete Racial/Ethnic Data Chart below. Racial/Ethnic data is collected on the free/reduced price meal application. If the parent does not voluntarily fill in this information, a school official may fill in the data based on observation.
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Aggregated Totals
Report Total Student Population by Identified Categories Listed (unduplicated count)
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All fields below must have a number. Enter a zero “0” if there is no data.
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Total District
Enrollment
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No. Approved for Free/ Reduced Price Meals
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Number Denied
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Number of Food
Service Staff
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