Civil Rights Compliance - United States Department Of Agriculture printable pdf download

Civil Rights Compliance

The United States Department of Agriculture (USDA) outlines the responsibility of each School Food Authority (SFA) in regard to Civil

Rights Compliance. The following form provides an overview of Civil Rights requirements in accordance with USDA FNS Instruction

113-1. Please complete this form annually by December 15th and maintain on file for program review purposes. Please note, the

information gathered in this form is confidential and should only be made available to authorized State and Federal personnel.

Sponsor Name

CTD Number

Date of Completion

Yes

N/A

1. Is the complete nondiscrimination statement included on the parent letter and all other printed material?

2. Have any complaints of discrimination (written or verbal) been received this school year?

a. If Yes, have they been acted upon according to the sponsor’s written procedures?

3. Is the And Justice for All nondiscrimination poster displayed at the Point of Service (POS) in each school?

4. Is program information made available to major employers contemplating layoffs?

5. Is there a need for program materials to be printed in a language other than English?

a. If Yes, has this been done?

6. Do admission procedures restrict enrollment by minority persons?

7. Are disabled students (including those with dietary needs) provided program benefits as

appropriate?

8. Using the racial/ethnic information from the household applications for free and reduced price meals,

complete the data charts below. SFAs will report the number of students in each category. For SFAs that are not

required to collect household applications, enrollment information may be used.

ETHNICITY

Free

Reduced

Denied

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central

American, or other Spanish culture or origins, regardless of race. The term “Spanish

origin” can be used in addition to “Hispanic or Latino.”

Not Hispanic or Latino: A person who does not meet the description above.

Please note, all students listed in the Ethnicity data chart must also be included in the Race data chart shown below.

RACE

Free

Reduced

Denied

American Indian or Alaskan Native: A person having origins in the original peoples

of North, Central, or South America, and who maintains cultural identification

through tribal affiliation or community recognition.

Asian: A person having origins in any of the original peoples of the Far East,

Southeast Asian, or the Indian subcontinent. This area includes, for example,

Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands,

Thailand and Vietnam.

Black or African American: A person having origin in any of the black racial groups

of Africa. Terms such as Haitian, or Negro can be used in addition to Black or African

American.

Native Hawaiian or Other Pacific Islander: A person having origins in any of the

original peoples of Hawaii, Guan, Samoa, or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, North

Africa, or the Middle East.

Total Students:

This institution is an equal opportunity provider.

Civil Rights Compliance - United States Department Of Agriculture

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