Steven L. Beshear - Terry 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 500 More Street a Frankfort. Kentuoky 40601
Phone: 1502) 584-4770 - 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, Carol Roy, as the duly authorized representative of Adair County Board of Education Food Service, do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain~rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole graln~rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2.015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hatdship(s).
The temporary exemptions are allowed for any type of grain product(s), leg, pasta, bread, brown rice, etc.) and for one
or more different products. SFAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the S?r 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014-2015 and 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed. include in the other hardship section. List the grain productls) to be
exempted.

An Equal Opportunity Employer 

 

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentationh

 

Financial hardship: The records demonstrate a signi?cant
drop in rneal counts after the whole grain-rich productis) was
offered.


WG BlscuitstG French Toast, WG-
Pancakes, W6 Pizza Crust, W6
Breeding on Chicken S?fips, WG
Crackerv

 

Financial hardship: The SPA experienced a signi?cant cost
increase when procuring the whole grain-rich productls). it}

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain?rich product(s)
offered by the SFA did not retain the desired texture or lost
paistahility during the typical holding time.

Same as above

 

 

Yes



List the type of grain produc?s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productls}
offered by the SPA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grainorich productls) was offered multiple times
and over a sustained period of time.

Participation has dropped
tremendously in the NSBP and
some in the NSLP due to product
acceptability.?

 

 

 

Other hardship (please list):

 

 

List alternative product types} brands that have been utilized:

 

Grain item

Manufacturer

Product Code

 

 

 

 

 

 

 

Product Description
we Biscuit Rich?s an
WG Pancakes, Pillsbuw&?ggo .. I
French Toast
Sticks, 
we Pizza Crust, Schwan?s 8: little GFS
Caesars
Strips,WG Tyson
Zeta

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at ieast half of the grain items offered weekly 15 whole grain- -rich.

0,0431% 

Sign - ture of Director of Scho Date
1.



ApprovedProgram Ma neger I Date

      
   
    

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer."

Page 3 of 3

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113?234, for school food
authorities (SPAS) to request exemptions from the whole grain rich requirements in the Nations! School Lunch Program
(NSLP) and School Breakfast Program through the school year 2016-17. Ali temporary flexibilities approved by a State

Agency under this superseded memorandum may continue under the terms they were approved, through schooi year 2016?
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productis) for the
2016.1? school year. This extension will be in effect for the 20164.7 school year and the SPA is responsible for ensuring

availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

 

 

 

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain
an Extension of Waiver is Hardship, Limited Product Availability, Products,? Brands That Have Been
requested. Poor Student Acceptabllity, Other) Tried and Were not Accepted
Whole Grain Biscuit Poor Student Rich's
Low Breakfast Participation Pillsbury
Whole Grain Pizza Poor Student Acceptability Schwan?s
Crust Low Participation
Whole Grain Chicken Poor Student Acceptability Tyson
Strips Low Participation Pilgrim?s Pride
Whole Grain Poor Student Acceptabilily Zesla
Crackers Low Participation

 

 

 

 

My signature indicates that i understand and attest?to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain-rich.

(lmollrhe (M. 

 

 

Director of Schools Date
?2 
MC Program Coordhi/ator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 1 of1

 

Matthew Bevin Stephen Pruitt. 
Governor Commissioner of Education

ND WORKFORCE DEVELOPMENT CABINET
EPARTMENT OF EDUCATION

Ca Plaza Tower I 500 Mero Street - Frankfort, Kentucky 40601
Phone: (5021564-4770 - 

Request for Exemption for Low-Fat Flavored Milk
For School Year 2017-18

I, CarOl Roy 

. as the duly authorized representative of Name]. do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(c] of the Appropriations Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk fat)
flavored milk through the NSLP and the SBP 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.

Documentation Submitted
(invoices, waste study,
YES Hardshipls): production records, etc.)

 

Signi?cant decrease in milk sales since implementation of the
current meal pattern. 5M5

Declining milk sales despite offering alternative products and
brands.

 

 

A food waste study indicating signi?cant waste of fluid milk.

 

Significant negative feedback from students and parents regarding
lack of availability of low-fat, flavored milk

 

Signi?cant negative feedback from students regarding the
palatability of fat-free, ?avored milk.

 

 

 

 

 

KentuckyUnbndedSpintcom .i-?Kza An Equal Opportunity Employer 

WRIT

My signature indicates that understand and attest to the accuracy of the information provided above.
support the information are available upon request by the State Agency.

7142/ {1-5?41

that all records to

 

 

Signature of Director of School N?tion Program Date
App?wed P'rogram Manage? Date

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer."

Page 2 of 2

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

i, ?Shoe-K as the duly authorized representative of ll?fk) 1605: Name],

do hereby attest that the aforementioned SFA and all schools under its iurlsdiction demonstilate a hardship in'procuring
compliant whole grain?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed thejecretary of Agriculture to allow State Agencies
that administer the National School (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain?rich requirement in the meai programs, in school years (5Y5) 2014-2015, 20152016 and

2016-2017 to a school food authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich

products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole

grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain~rich productls) for SY
20162017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33?2016

Page 1 of 3

- 

Yes

Hardshiplsi:

List the type of grain productls)

to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

 

 

 

 

Flnancial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich produc?s}.

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich producds) in the local market and
would like to offer enriched grain items} temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain~rich productls)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

Yes

Hardshipls]:

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole graiwrich productls}
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain~rich product{s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 



 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekiy Is whole grain-rich.

b??oi?z/ /0 4G 

Director of$ hools Date 

WW {0 6 

Prc?r am Coordinator Date

 

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandre.wagner@educationkggov.

is an equal opportunity provider and employer.?

Page 3 of3

Request for Exemption for Whole Grain?Rich Requirements
School Year 2018-19

I, as the duly authorized representative of Name], do hereby attest
that the aforementio? SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or

sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole gra rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the isted whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain to be exempted.

 st the type of grain product(s) to
be exempted and attach
justification documentation

Hardshipls): (production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain~rich product[sl.

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

 

I. st the type of grain product(s) to

be exempted and attach

ar dshipls): justification (production records,
meal counts, student?s letters,

SJrveys, etc.): .3.
LA.) (711%. 21' 
Poor student acceptability: The whole grain-rich offered by U342, omc?-Q-?I, 0% a:
the SPA received signi?cant negative student)r parent feedback or there LO 51' .
4 

was increased plate waste of that menu item when the whole grain- w. 
rich productls) was offered multiple times and over a sustained period Wk?t 

of time.
Other hardship (please list): ?omal WEB-L 
WW WM
WSW .

 

 

 

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

WGW 
Rick's

 

 

 

 

 

 

 

 

 

 

Hardship(s):

Let the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

1 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired

texture or lost palatability during the typical holding time.

 

WWK: 

 

 

Hardship(s):

st the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s ietters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-

rich productIs) was offered multiple times and over a sustained period-

of time.

a *3 


W.

 

Other hardship (please list):

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 



Mocmmn?

Cave. Wx

 

 

 

 

 

 

 

 

Hardshipls):

1. st the type of grain productls) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
rneal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whoie
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardshipls):

1. st the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,

5 Jrveys, etc):

 

Poor student acceptability: The whole grainsrich productls) offered by
the SPA received signi?cant negative student/ parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

message
4W -

 

 

Other hardship (please list):

 

 

 

List alternative product types] brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

Mews

(sits {sac-Si,

 

 

 

 

 

 

 

my slgnature Indicates that I understand and attest to the accuracy ot the inrormatlon prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

haw fit-[3M8

 

 

 

 

Signature of Director of School Nutritibh Program Date
somMC Program Coyb?ator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra .wagner@education Ky gov

KDEISCN Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015. 

Sponsor Name: We? WULQY >Egkog?b4u Jew mw }\2x35\
Name of Product a waiver is being requested for: Wk?mw 

Brand Name of product used: 

Recipe(s} in which the product is used: 

(?13 WW
Other productstested; ini/QAW (El/awoj?d?e?gakxe? @1040

ewu?u? mee muck
879.? mumks 
WW WE $09-55?) 5
kae) WK ?s ('3ka 

issues with products used and tested:

CM
0 QWW ~1de WARM 
Internal Use Only wW?? 

 

Date Submitted: ?7 #511,411

Date Approved: 7 ?<93 

ApprovingSignature: i 
issue/J mime *aktmp 'm Wdetw?g

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: 

Name of Product a Waiver is being requested for: Lt) WVJ-kafx @908? 

Brand Name of product used: WM 

v: 
Recipe(s) in which the product is used: AWw?k EM

- . . 
Other products tested: kw

a
issues with products used and tested: U3 WEKQ Ckmw?i 

WMHU ?41
wasps was MEX

internal Use Only
Date Submitted:
Date Approved:

Approving Signature:

RM ?ewswwiw ?bps/59W pd mics 3r! some.

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary ?exibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved, through school year 2016-17, at the discretion of the State agency

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich
product(s) for the 2016-17 school year. This extension will be in effect for the_g01 6-17 school year and
the SPA is responsible for ensuring availability of whole grain rich products to meet the 100 percent of
grains offered must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship, Limited Product That Have

Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability, Other) Accepted

 

6" (EL 8001.) Fossil. SWAQIKT [Sag-a; If)?
MQCMEM ?306159 rt? Matti tel-LewixSeeJ- m;

 



 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure it?? lea half of the grain items offered weekly are whole grain rich.

Nita-?rd 7re?7?/?3

Signature o?birector of Schools(/ District Data
(PM 

begram Coordinator" I Date

Please complete this form, sign, and electronicaiiy submit to Sandy Wagner at 

      

 

 

Hal Heiner

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower 0 500 Mere Street Frankfort, Kentucky 40601
Phone: (502) 564-3141 I on.ky.gov
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
. . Anderson County Schools
I, Ronnie Fields . as the duly authorized representative of Name], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32?2017
SP 33-2016


mtuck 
SPIRIT An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

Biscuits, Spaghetti

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record}:

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Biscuits, Spaghetti

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Whole Grain 2.51 ounce Pillsbury 132268000
Spaghetti Whole Grain 51% Dakota Growers 6738791322

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency.

Digitall 5' nedb nnie Fields
Ronnie Flelds 3?5-18

Signature of Director of School Nutrition Program Date

 

 

MM 3?9-4?

Program Coor In or Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

A
Kentucky's?
KentuckyUnbridledSpint corn UNBHIDLED sermr An Equal Opportunity Employer MIFID

Wagner, Sandra - Division of School and Community Nutrition

From: Wagner, Sandra - Division of School and Community Nutrition

Sent: Tuesday, July 29, 2014 10:05 AM

To: Fields, Ronnie

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition; Crouch, Valerie -
Division of School and Community Nutrition

Subject: Whole Grain Pasta Waivers

Ronnie,

Your requests for waivers for whole grain pasta for your spaghetti and rotini have been denied.

We would ask that you try other products such as a tri color rotini or a different brand of whole grain
spaghetti. Other districts have had success with Bariilla spaghetti and tri color pasta. Other districts have also had some
success with mixing the spaghetti and sauce prior to service. The waivers are only temporary and the intention is that
you would continue to look for acceptable whole grain products.

if you try other products and continue to have a significant drop in student acceptance, please feel free to apply
again for a waiver. 
I if you have any questions, please feel free to contact me.

5m} Mtg/ran 

Program Coordinator

Kentucky Dept. of Education

Division of School and Community Nutriiton
(502) 564?5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or parental status, sexual orientation, or if all or part of an individual?s income is derived from any
public assistance program, or protected genetic information in employment 'or in any program or
activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs
andjor employment activities.)

If you wish to ?le a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complaint Form, found online at

tiling or at any USDA office, or call (866) 632-9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture,
Director, Of?ce of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 20250-9410, by
fax (202) 690-7442 or email at program.intake@usda.aov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 8778339; or (in Spanish).

USDA is an equal opportunity provider and employer

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

1, JaCk M'nlard . as the duly authorized representative of App. Challenge-Academy Name],

do hereby attest that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in thisdocument
pose a chailenge in offering whoie grain-rich products. in Section 751 of'the Consolidated and further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to aliow State Agencies
that administer'the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an'exernption-
from the regulatory whoie grain-rich requirement in the meal programs, in school years (3Y5) 2014-2015, 2015-2016 and
2016-2017 to a schooi food authority (SFA) that demonstrates a hardship in procuring compliant Whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products. -

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate coiurnn or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-20-16

Page 1 of 3

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productis) was
offered.

 

Financial hardship: The SFA experienCed a significant cost
increase when procuring the whole grain~rich productis).

 



Limited product availability: The SPA does not have access to a
compliant whole grain-rich productis) in the local market and
would like to offer enriched grain item(s) temporarily.

 



 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
paiatability during the typical holding time.

 

Biscuits. Tn? Color Roiini. Elbow
Macaroni, Spaghetti, Breeding on
Chicken Nuggets -

 

 

Yes

Hardshipis):

List the type of grain productisi
to be exempted {attach
production record):

 

Poor student acceptability: The whole grain-rich productls)
offered by the SFA received significant negative studentfparent
feedback or there was increased plate waste of that menu item
when the whole grain-rich produc?ds) was offered multiple times
and over a sustained period of time.

Biscuits, Tri Color Rotini,
Elbow Macaroni, Spaghetti,
Breeding on Chicken
Nuggets

 

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

Page 20f3.

My signature indicates that I understand and attest to the accuracy of the information provided above, that-all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption

    
 





?uorofSchools Date
Alma/M I 

toot/War Date

*Plea?e complete this form, Sign, and electronically submit to Sandy Wagner at sandra.wagner@ educationkmgov.


is an equal opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite . Frankfort, Kentucky 40601
Phone: (502) 56445625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Limbo CEMADM . as the duly authorized representative of?sh?mb Tnd. Name], do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshiplsl.
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,

and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Kmmer?A

KentuckyUnbridledSpidtcom mama? An Equal Opportunity Employer 

Hardship(s):

 

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in .

i meal counts after the whole grain-rich product(s) was offered.

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). DJ

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

[109! E00
(Picket as ?Widvd 9c?

 

 

Hardship(s):

 

a.

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

 

the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

we boo 
(Silibmt laid-W indudefb

 

Other hardship (please list):

 

List alternative product types/brands that have been utilized:

 

 

Manufacturer

Grain Item Product Description



 

 

Product Code

I
.1-


1

 

 

. . 

Q:

My Signature Indicates that I understand and attest to the accuracy ot the Inrormatlon provnded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

8% Wld?L ?g ?41m W0 I 5?

I, I

Signature of Director of School Nutrition Program

 

Program Coordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

ruckgi?
An Equal Opportunity Employer MIFID

UNBRIDLED 3PIR1T

Hal Helner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Meta Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Mhicmc) lex?Qwaimi Sci/too?

l, 060 as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 747 of the Appropriations Act provides ?exibilities related
to whole grains, sodium and ?avored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate 
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpirit.com Wow-urgi- An Equal Opportunity Employer MIFID

List the type of grain productts) to
be exempted and attach

Hardshipls): justification (pictures, receipts,
etc. for documentation): 5
HQ 9,

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls). El

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain item(s) temporarily.

Preparation Hardship: Unacceptable product quality: The whole 
grain-rich product(s) offered by the SFA did not retain the desired LOG 

texture or lost palatability during the typical holding time. 

 

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

record): I 000C506.)

Poor student acceptability: The whole grain-rich product(s) offered by mm He
the SPA received significant negative student/parent feedback or there 
was increased plate waste of that menu item when the whole grain- 
rich product(s) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

Hardship(s):

 

 

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

.. egrlature Indicates that I understand and attest to the accuracy or the Intorrnatron provrdeo above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

MM Pitta. 70300

Signature of Director of School Nutrition Program Date 



Program Coorc?rrator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

A -13
Wj_ An Equal Opportunity Employer 

9?0 comma?);
A a?
?r


?tr-re.

scnooz

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Amber Hayes as the duly authorized representative of Ballard County Board of Education, do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

'The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

WG Biscuit

WG Cracker
WG Tortilla
WG Pasta

 

Hardship(s):

 

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Biscuit

WG Cracker
WG Tortilla

WG Pasta

 

Other hardship (please list):

 

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Pillsbury 2.2 oz. biscuit General Mills GFS ii 866920

Cracker Saltine Cracker GFS GFS if 870400

Tortilla 6? White Tortilla LaFronteriza 702633

i Pasta 10 in. pasta spaghetti Kitchen Essentials GFS ll 654560

 

 

 

 

 

 

 

 

My Signature indicates that I understand and attest to the accuracy ot the intormation prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

I 57/6 

 

 

 

 

Signature of Director?of School'Nutrition Program Date
Program Coordinat?t? Date

Please complete this form. Sign and electronicallyI submit to Sandy Wagner at Sandra wagner@education ky gov

 

Steven L. Beshear
Governor

itNi} WORKFORCE 
DEPARTMENT OF 

Capitai Plaza Tower at 500 Mere Street as Frankfort, Kentucky 406
Phone: {582) 

Request for Exemption for Whole Grain?Rich Require:
School Years 2014-2015 and 2015?2016

t, Amber Hayes, as the duly authorized representative of Ballard County Schoot Distric
aforementioned SFA and ali schoots under its jurisdiction demonstrate a hardship in proc
rich products that are acceptabie to students, and that the factors indicated in this do
offering whole grain-rich products. to Section 751 of the Consotidated and Further Contioc
(Public Law 113-235), Congress directed the Secretary of Agricuiture to aliow State A
National Schooi Lunch Program (NSLP) and Schooi Breakfast Program (SBP) to grant an ex
whole grain-rich requirement in the meat programs, in school years (5Y5) 2014?2015 and
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich pro
students.

The State Agency may approve an exemptiooreqoest for specific products if the SFA
The temporary exemptions are allowed for any type of grain productis), pasta, bread,
or more different products. SPAS granted an exemption must work with the State Ager
products. and must comply with the SY 2013-2014 requtrement of at ieast haif of the grai
grain-rich products.

The State Agency wili consider hardship factors in allowing an exemption for the tisted 
the remainder of Si! 2014-2015 and SY 2015-2016. Place an tn the appropriate colour

hardship consideration. ifyour hardship is not listed, inctode in the other hardship section. 1
exempted.

KentuckyUnbridiedSpiriticom An 

   

 
 

unempcso swim

terry-"Holliday. Phi).
of Education





nents

do hereby attest that the
uriogicompliaot whole grain?
cumdot pose a chattenge in
ing Appropriations Act, 2015
gencips that administer the
emptlon from the regoiatory
201552016, to a school food
ducts that are acceptabte to

tan demonstrate hardshipis).

brown rice, etc.) and for one
to search for acceptable
ns offered weekly are whole

tote grain-rich productis?) for
or 2coiumns (Yes) for each
.ist the grain productls) to be

Equal @pportunit?y Employer MIFKD



 

List the type of grain productls)
to be exempted and attach
Yes Hardshipls): justification (pictures, receipts,
- etc. for documentation}:

 

in: Financial hardship: The records demonstrate a significant WhoieG'ain Biscuit
drop in meal counts after the whole grain-rich productis) was
offered. -

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product?s).

 

Limited product availability: The SFA does not have access to a Whoie Grain Zejsta Crackers
compiiant whole grain?rich produc?s) in the iocal market and
would like to offer enriched grain itemls) temporarily.

 

Unacceptable product queiity: The whole grain-rich productls) Whole Grain Biscuit
offered by the SFA did not retain the'desired textureor iost . .
during the typicai holding time. Whole Grain 295? Crackers

Whole Grain Tortilla

 

 

 

 

 

List the type of grain productls)
Yes Hardshipls): to be exempted (attach
production record):

 

 

 

Poor student acceptability: The whole grain~rich productls) Whole Grain Biscuit
offered by the SFA received significant negative student/parent .
feedback or there was increased plate waste of that menu item Whole (3mm 2933 5?35??
when the whoie rain?rich roduct was offered multi le times -
?g i . i 9 Whole Grain Tortilla

and over a sustained period of time. 

 

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

Grain item Product Description Man-diacturer . 3roduict Code
Cracker Sunshine Harvest Wheat General Mills #114378 i
Biscuit Biscuit Ralcorp/ Con Agra #10077 CRS
Tortilla Tortilla Mexican Original #1390? CF 3

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information or
to support the information are availabie upon reqnest by the State Agency, and that the
must ens re that at feast haif of the grain items offered weekly :5 whole grain? ?rich.

Jog/U [31% My

Signature of Directoro Sc 00 

     

.. 

Page 3 of 3

 

wideo above, that an records
SFAs '{eceiving the exemption

 

Wagner, Sandra - Division of School and Community Nutrition

From: Wagner, Sandra - Division of School and Community Nutrition
Sent: Thursday, April 16, 2015 12:35 PM

To: Cecil, Greta

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition
Subject: WG Exemption

Greta,

We received your request for an exemption from the whole grain rich requirements for pasta and biscuits.
Can you send production records, photos or some other form of documentation to show a drop in participation
or the holding issues? if we can get documentation, we will be able to get this approved for you.

Thank you,

my Myra Aerie arr

Program Coordinator

Kentucky Dept. of Education

Division of School and Community Nutriiton
(502) 564-5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or parental status, sexual orientation, or if all or part of an individual's income is derived from any
public assistance program, or pi otected genetic information in employment or in any program or
activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs
and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complaint Form, found online at

?ling cust.html, or at any USDA office, or call (866) 632-9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture,
Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 202509410, by
fax (202.) 690-7442 or email at program.intake@usda.gov.

Individuals who am deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 877 8339; 01 (800) 845 6136 (in Spanish).

USDA is an equal opportunity provider and employer

 

Steven L. Beshear Terry Hold-day, Pita.
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
)r 5? EDUCATION
ii

Capital Plaza Tower 0 500 Mere Street 0 Frankfort, Kentucky 40601
6} Phone: (502) 564-4?70 mmeducatiomkygov

i?
i 

Request for Exemption for Whole Graln~Rich Requirements
School Years 2014-2015 and 2015?2016

l, Gift/?71 as the duiv authorized representative of . 7 Name}, do hereby attest
that the aforementioned SPA and all schools under its jurisdiction demonstrate a hardshi in procuring compliant whole
grain?rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole graimrich products. in Section T51 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113435), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 20113?2015 and 2015?2016, to a school food
authority that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

 

The State Agency may approve an exemption request for specific productsif the SFA can demonstrate hardshipls}.
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
graiwrich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014~2015 and SY 2015~2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

KentuckyUnbr?dledSpiril.com

 
 

 
 

An Equal Opportunity Employer MIFID

Nemocso SPIRIT

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
iostification (pictures, receipts,
etc. for documentation):

 

 

Financiai hardship: The records demonstrate a significant
drop in meat counts after the whole grain-rich produc?s] was
offered.

 

Financiai hardship: The SFA?experienced a significant cost
increase when procuring the whole grain-rich productis). 

 

 

 

 

Limited product The SFA does not have access to a
compliant whoie grain?rich productis) in the market and
wouid iike to offer enriched grain itemis temporariiy

{Rifecceptabie product quality: The whoie grain? ?rich productis s)

offered by the SFA did not retain the desired texture or lost
during the typical hoiding time

name tori i8

 

 

(Cite. he? 8am

 

Yes

Hardship(s):

(10

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

 

 

 

 

 

Poor student The whoie gtain? rich producsti s) . . .
1 . 
offered by the SFA received significant negative student/patent mug-AB?? Well/E}
feedback or there was increased plate waste of that menu item n5?

when the whoie grain- -rich productis s) was offered multiple times 

and over a sustained period of time. gb??hwt

Other hardship {please iist):
List aitemative product typesIbrands that have been 

Grain Item Product Description Manufacturer

Woduct Code

 

mag mm *4 Chalet? Wm

?57%

 

Q: as?)

6h) 

 



 

 

 

 

 

 

 

 

Page 2 of 3

Wigidi?o 

?315? 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, elf-Ch GO as the duly authorized representative of M. Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain- r-ich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole graln- rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act 2015 (Public Law 113- 235) Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain- -rich requirement in the meal programs In school years (5Y5) 2014 2015 2015- 2016 and
2016- 2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain- -rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is

not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference- SP 33-2016

Page 1 of 3

Yes

Hardshipts):


List the type of grain product(s)

to be exempted and attach

justification (pictures, receipts,

etc. for documentation):
1

 



?financial hardship: The SFA's records demonstrate a significant
drop in meal counts after the whole grain-rich product(s} was
offered.

00W Wt?

 

El

Financial hardship: The SFA experienced a significant cost
increase when procuring whole grain-rich product(s).

 

[1

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 



 

,U?acceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

.. 

 

EL

 

6

 

Yes

Hardship(s):

cilia}- swim

List the type of grain product(s)

to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)

ed by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product{s) was offered multiple times
and over a sustained period of time.

mewm?w



 

Other hardship (please list):

 

 

 

Wall.-

N?a?w

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Biscudr 605m "Peach Uallal

Pue moo Lama

 

?B?us

Octal?

 

 

0443' 6150qu 

 

 

615.com: we 6mm misbw;

 

stua? salami

 

 

Page 2 of 3

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption

that at least half of the grain items offered weekly is whole grain-rich.

 

   

Director of Schools Dat
Z- #79
Date

 

SC IMC Program Coordin

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Helner

Secretary

Education and

Workforce Development Cabinet

?atthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plan Tower - 5110 Nero Street 0 Frankfort. Kentucky 0601
Phone: {502) 581-3141 0 

Request for Exemption for Whole Grain-Rich Requirements 8 aL-Hrv. Car-W
School Year 2017-18

- Will?
I, ML as the duly authorized representative of EA Name]. do hereby attest

that the aforementioned SFA and all schools under its iurisdiction demonstra a hardship in procuring, preparing, or
serving compliant whole graln'rich products that are accepted by students. and that the factors indicated In this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains. sodium and ?avored milk tor school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls} The
exemptions are allowed for anv type of grain productlsi. leg. pasta. bread, brown rice. etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least hall of the grains
o?ered vreelrlv are whole graln-rlch products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 20 18
school vear. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extensions from 5? 2016-17:

All exemptions approved bv the Division of School and Community Nutrition, KDE, under 5P 33-2016. Exemption Not ce:
Request ior Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17. April 29, 2016,
may continue under the terms by which theirr were approved, through SY 2017-18.

'Reference: SP 32-2017
SP 33-2016

ruck? 

Ker?ucirvUnbridledSpiritoom Karl-noun 3,,ng An Equal Opportmiir Employer 

List the type of grain productis) to
be exempted and attach

justi?cation (pictures, receipts.
etc. for documentation):

 

Hanoi-Ilium: The SFA's records demenstrate a signi?cant drop in

mim?terdseuhoiemrn-ridr productis) was offered. FINN [Olgc [05" 
hairline The SPA experienced a signi?cant cost increase OW In 3 (36' 

Ida-n mil-{the whole grain-rich productis).

lhdced man The SFA does not have access to a
moire ruf?e [ram-rich productis) in the local market and would
Eeto offer enriched grain itemis) temporarily.

Preparation W9: Unacceptable product quality: The whole
gain-rich productis) offered by the SPA did not retain the desired
term": or lost oalatabi?ty during the typical holding time.

 

 

 

 

 

 

 

List the type of grain product?s) to
Hardshipis): rczz?rnpted [attach production

 

Poor student acceptability: The whole grain-rich oroductis) offered by

the SPA received signi?cant negative studentlpa rent feedback or there Lb 80-de

was increased plate waste of that menu item when the whole grain- 3 (1.2 2!

rich productis) was offered multiple times and over a sustained period 
of time.

Other hardship [please list):

 

 

 

 

 

List alternative product types/brands that have been utilized:

Grain item Product Description Manufacturer Product Code

 

My signature indicates that I understand and attest to the accuracy of the lntonnatlon provided above. that all
r: or- sup - the Infon'na - re available upon request by the State Agency.

   

 



Date

3- 5'7?

SCMIMC Program Coordin?'or Date

 

Please complete this form. sign. and electronically submit to Sandy Wagner at 5andra.wagnar@educatton kygov

KmMyUrbddedSpintmn-t K01 ?Hump tun-1:7y An Equal Opportunity Employer 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mero Street - Frankfort. Kentucky 40501
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18


I. elf-Gib. Ce:- as the duly authorized representative of Name . do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demon ate a hardship in procuring, preparing. or
sewing compliant whole grain-rich products that are accepted by students. and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides fl xlbilities related to
whole grains. sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls). pasta. bread. brown rice. etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain to be exempted.

Automatic extensions from SY 2016-17:
All exemptions approved by the Division of School and Community Nutrition. KDE, under SP 33-2016. Exemption Notice;
Request for Exemptions from the School Mealsr Whole Grain-Rice Requirements for School Year 2016-17. April 29. 2016.

may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32?2017
SP 33-2016


murder: in
An Equal Opportunity Employer MJFID

KentuckyUnbridledSpintcom unsaroczo sernrr

List the type of grain productis) to
be exempt and attach
justi?cation (pictures, receipts,

Hardship(s):
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Li it il biliave access to a A?Slm RCA le

compliant whole grain?rich productis) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain to
be exempted (attach production

Hardship(s): record)-

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was Increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):
M15 a UJ??aSiarT?in
Mame tam m3 (1?51?de-

 

 

 

 

List alternative product types! brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above. that all

recgds to support the information are available upon request by the State Agency.

Signature of Director of School Nutrition Program Date

 

r21 7~5"l7

SC to Program 5' meter Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentuckyUnbndiedSpintcom An Equal Opportunity Employer 


Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, th Cf?! as the duly authorized representative of I Ellis-h) Kill?! Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate hardship in procuring

compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State AgenCIes
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls)
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain~rich products.

The State Agency will conSIder hardship factors in allowing an exemption for the listed whole grain-rich productlsi for SY
2015-2017 Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship I5

not listed. include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain productls)
to be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productis) was
offered.

 

Financial hardship: The SFA experienced a Significant cost
increase when procuring the whole grain-rich productis).

 

ed product availability: The SFA does not have access to a
compliant whole grain-rich productts) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

mama

Unacceptable product quality: The whole grain?rich product(s)
offered by the SFA did not retain the desired texture or lost
palatabliity during the typical holding time.

 

 

926i hoodi?S
DU

 

 

Yes

HardshipLs):

List the type of grain productls)
to be exempted [attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis] was offered multiple times
and over a suStained period of time.

 

 

Other hardship (please list):

GPS eBaagH has been
disCmi-HM.

 

 

056 novella/3

 

 

List alternative product types/brands that have been utilized:

- 

i"

Product Code 1

 

 

(--

Grain item Product Description Manufacturer

 

 

 

 



 

Page 2 of 3

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption

mus nsure that at least half of the grain items offered weekly is whole grain-rich.

nib/UM M/y

 

"omens? of Schools Date
Date 

 

?Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer."

Page 3 of 3

 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individua! pasta product for which a
waiver is desired for SY 2014 2015.

SponsorName: Ojij 8&ng

Name of Product a waiver is being requested for:
lag-gag fajita. an?i?g ?3}de

Brand'Name of product used:
lm-szaga?mg?i a} WM 
?2 
51y g?srlc 2? Du {:10ch
Recipe(s) in which the product is used:



Other products tested: 
gala-5mm



issues with products used and tested:

Internal Use Oniy

 

Date Submitted: 7271 ?4
Date Approved: 7 3 Fl 11

Approving Signature:
094/wa

M0 (9W prank} avatcdai/ 1" U9 6?

 

 

KDEISCN Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Cit/1 @4006

Name of Product a waiver is being requested for:

{?fe-e ?1.30 

Brand Name of product used:

1
om em exam 5 

[36th lvjk?oi?goo?ng-M7: Daisey? i??eoei? ?Jaime: .
Recipeis) in which the product is used:

figuregizio me??c Stu-e13

Other products tested: 
i31i5?t-l?-E?" a 


issues with products used and tested:

internai Use Oniy

 

Date Submitted: 7 \Fi 

Date Approved: 013-? 

Approving Signature: 
0*ka 

VFwawWodidqiSSM, wmmom compkuwh ?gnwx?w,

KDEISCN Prior Waiver Request for Whole Grain Rich Pasta 2814-2015

Instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: ?bde?DUm 

Name of Product a waiver is being requested. for:
EL 30W (??rm-?119w:

Brand Name of product used:

{933$ 9m gig-?62313
DRKMIR hiked? ?yiualgm?x}

Recipe(s) in which the product is used:
c?ulgl?ggj?;

Other products tested;
dogma mid, 

Issues with products used and tested'
div-{- Maud ?3 5&9ng
2 . . 13. 

Nodal 1?1: ?aws; ?ge?fz?g
{i1 agiw?d good 349% we?,

Internal Use Oniy

 

DateSubmitted: 7121'"! 

Date Approved: 7 

Approving Signature: w??w

Wot 01W Whip/w WWQW WLIJASWB
4n) ?sdodW?k

 

 

 

Hal Heiner

 

Matthew G. Bevin Secretary
Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower . 500 Mere Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0. 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
CheyAnne Fant 
i, . as the duly authorized representative of Narne], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for speci?c products if the SPA can demonstrate hardshipts). The
exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

SCNIKDE will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the 2017/18
school year. Place an in the appropriate column or columns [Yes] for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

7? Md} 3%
KentuckyUnbridledSpiriLoom ?g An Equal Opportunity Employer MIFID

UNBRIMD 

 

 



List the type of grain productis) to
be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

Signi?cant drop in lunch participation

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s].

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productisl in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

Whole grain paste is hard to cook.
not appealing. favor is not good.
Crackers are like cardboard

 



List the type of grain productis) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain?rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Students acceptability of
Pasta and Crackers are noted
in letters attached.

 

Other hardship [please list]:

 

Barren County prides itself in trying
to serve nutritious meals that
students love and want to come
back for. Whole Grain pasta and
crackers are not what the students
want to come in for.

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Pasta Spahettia Noodles GFS GFS - 654590
Crackers Salteen Westiminster GFS - 3001 7

 

 

 

 

 

 

 

 

 

My signature Indicates that I unoerstano and attest to the accuracy ot the intormation prowoed above. that all
records tWaport the infor tion are available upon request by the State Agency.

(c 0AM. ?ll/4?
Signature @irector of School Nutrition Program D'ate'

5?373;

SCNNIC Program 0035?er Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandramagner@educalion.ky.gov

Kat/twat? it

UNBRIDLED SPIRIT

An Equal Opportunity Employer MIFID

 

Steven L. Beshear . Terry Holiiday, Phi).
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF 

Capital Piaza Tower 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 564-4770 meweducatiomkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, CheyAnne Fant, as the duly ?authorized representative of Barren County Schoois, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a chalienge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Pubiic Law 113-235), Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the reguiatory
whole grain?rich requirement in the meal programs, in school years (3Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SEA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s}, pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekiy are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for
the remainder of SY 2014-2015 and SY 2015?2016. Piace an in the appropriate coiumn or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain producds) to be
exempted.

KentuckyUnbridiedSpiritcom An Equal Opportunity Employer 

       



UNBHIDL 

 
 

Yes

Hardshiplsj:

List the type of grain productls)
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation)?

 

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whoie grain-rich productls) was
offered. - 

See ADP Chart below with notice of
signi?cant drop in breakfast with
most of these products in
breakfast.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productls).

The WG Pillsbury Biscuit is $0.15
per serving and the non-whole
grain is $0.13 per serving. Getting a
ore-made W6 pancake is $0.41 per
serving and making homemade
ones are only $0.06 per serving.
Signi?cant cost differences in the
chicken would also been seen if
processing commodities were not
taken off N01.

 

Limited product-availability: The SFA does not have access to a
compliant whole grain-rich productls) in the locai market and
would iike to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain?rich product(s)
offered by the SPA did not retain the desired texture or lost
during the typicai holding time.

 

Biscuits became tough during
holding period. Pancake texture
when making homemade pancakes
was tough and unpalatable and
were removed from the menu
midyear. Muitipie requests for the
comparable chicken have also been
stated.

 

 

Page

Yes

Hardshipls):

List the type of grain productls)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain~rich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productls) was offered muitiple times
and over a sustained period of time.

Student acceptability for these
three products has been noted in
comments from our Nutrislice app
which allows students and parents
to rate foods. Please see
attachment.

 

320M

 

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 



 

 

Grain item Product Description Manufacturer Product Code
Biscuit Pillsbury Whole Grain Biscuit Piilsbury 269210 GFS
Chicken Whole muscle, whole grain Tyson 533830 GFS
breeding
Pancake Mulitgrain mix 413210 and GFS Mix 413210 GFS

then tried Pillsbury premade Then Pillsbury
pancake packs and mini waffles
(Wholegrain Blueberry waffles,
strawberry pancake, and mapie
pancake)

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are avaiiabie upon request by the State Agency, and that the SFAs receiving the exemption
must sure that at least heif of rain items offered weekiy is whole grain?rich.

2779:7799 4?403?

Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equai opportunity provider and employer.?

 

 

 

 

 

 

2012-13 Lunch ADP 2013- 14 Luncti ADP. 2014 15 Lunch ADP
7-45 74.8 72.9
22.22.. 13.892472.st - 22.23.-.i242realsfast 2014453733444
- 3ADP3 -- -- ADP.

 

 

 

Nutrislioe Comments:

 

 

Rating Food item Student Name Comments

$5

3 Biscuits Thurston 8 It?s ok.
Gravy

 

 

 

 

 

Page 3 of 4

 

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (Sf-As) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary flexibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-

17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productls] for the
2016-17 school year. This extensipnwill be in effect for the 2016-17 school year and the SFA is responsible for ensuring
availabilg? of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement

for the 2017-18 school vear.

 

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain

an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. Poor Student Accepta bility, Other) Tried and Were not Accepted
Biscuits Breakfast participtation went Pillsbury whole grain biscuit

Rich's whole grain biscuit,

down. Bad rewews on Baker Chef whole grain biscuit

 

 

Pancakes Children did not like the texture of the Pillsbury whole grain ready to
whole grain pancakes. Bad reviews on serve. GFS Ultra Grain Mix
Nutrislice.

Tyson Chicken Breakfast participation went down. USDA Tyson whole grain

Tenders Children gave bad reviews of whole Chicken tenders

grain crusted chicken

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

(YMMV Mia

 

 

Director of 5 Date
La, 
MC Program Coo?dtor Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandra.wagner@ education.ky.gov.

is an equal opportunity provider and employer.?

Page 1 of 1

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mare Street 0 Frankfort. Kentucky 40601
Phone: (502} 564-3141 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

 

i, malt, Wt?) as the duly authorized representative Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate ardship in procuring, preparing. or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain?rich products. Section 747 of the Appropriations Act provides flexibilltles related to
whole grains, sodium and flavored milk for school year (SY) 2017-13.

may approve an SFA's exemption request for specific products if the SFA can demonstrate The
exemptions are allowed for any type of grain productls), pasta. bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE. under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

'ReferenCe: SP 32-2017
SP 33-2016

KentuckyUnhridledSpiril com ma; An Equal Opportunity Employer 

List the type of grain productlsi to
be exempted and attach
justification (pictures, receipts.


etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in

meal counts after the whole grain-rich productts) was offered. drama
. 

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain?rich productls).

 

limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain Itemis] temporarily. 
Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost palatahiilty during the typical holdinggme.

 

 

 

 

 

List the type of grain productls) to
be exempted (attach production

Hardshipis): record):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-

rich productis) was offered multiple ?nes and over a sustained period 
of time. h?ll'r?bl? ?b if lanai-5

 

list): CbSOkai'
Wildwf @Ln'll?d mm row
ram. we We: WW do
Mm" 905*? .
WI (ii/1cm. bea?i??iikh (ILLECLAQUQ 16wa mm

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

an rm 61.914MWL him . worm
lU \S?t Mails?) QR 3179;1le -GES
Cii?i?iL?tt Elm says-o 911:3

 

 

 

 

 

 

 

 

 

 

 

E2312

Date

 

Please complete this form, sign. and electronically eubmlt to Sandy Wagner at Sandra.wegner@educatlon.ky.gov

mg? An Equal Opportunity Employer WFID

9 (:0ng
0?21;-

SC ?Got

2

#0110"

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l. Regina Collett as the duly authorized representative of Bell County Schools Name], do
hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring,
preparing, or serving compliant whole grain-rich products that are accepted by students. and that the factors indicated in this
document pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipls). The
temporary exemptions are allowed for any type of grain productls), pasta. bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grainarich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. Ifyour hardship
is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardship(s):

 

List the type of grain productls) to
be exempted and attach
justi?cation documentation
[production records, receipts.
photos, etc):

 

Financial hardship: The SFA's recordsdemoh?strate a significantdrop in
meal counts after the whole grain?rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have-acgss to a
compliant whole grain-rich product(sl in the local market and would like
to offer enriched grain ?temlsl temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich productls) offered by the SPA did not retain the desired texture or

Ljost palatability during the typical holding time.

 

 

 

 

 

Hardship(s):

List the type of grain productis) to
be exempted and attach
justification [production records,
meal counts. student?s letters,
surveys, eth:

 

  
  

Poor student acceptability: The whole grain-rich productls} offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
productls) was offered multiple times and over a sustained period of
Aims; 

5 Other hardship (please list):

 

 

Biscuits and Pizza
Students will not accept the whole
grain biscuits or Pizza.

 



My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?Qc?lhik (f 

Signatdre of Director of School Nutrition Program Date



SCNIMG?PrograrrTCoordinatp?? Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky. gov

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary ?exibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich product(s) for the
2016-17 school year. This extension will be in effect for the 2016-17 school year and the SPA is resgonsible for ensuring

availabilig of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement

for the 2017?18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain

an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. Poor Student Acceptability, Other) Tried and Were not Accepted
Biscuits Students will not accept the whole grain Several brands have been tried with

biscuits. More than 50% or what is served is no improvement in acceptance.
thrown in the waste baskets, by the students.

 

Pizza Students will not eat the whole grain crust Tony's pizza as well as vendor pizza
pizza They say it tastes like cardboard and and other brands have been tried.
throw it away.

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

Me. Iggy/[L

irector of Schools
3112

Program ?oordir?i?if Date

 

 

?Please complete this form, sign, and electronically submit to Sandy Wagner at sand ra.wagnerQeducation.ky.gov.

is an equal opportunity provider and employer."

Page 1 of1

 

Steven L. Beehear Terry Holliday, mo.
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF 

Capital Plaza Tower . 500 More Street Frankfort, Kentucky 40801
Phone: (592) 5644?? 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, 2 2:14,: 2 as the duly authorized representative of ms? Name], do herebyI attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardsh in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole graio~rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant ao exemption from the regulatory 
whole grain-rich requirement in the meal programs, in school years (5Y5) 2614?2015 and 20152016, to a school food
authority (SFA) that demonstrates a hardship in procuring'compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemptlon request for speci?c products if the SFA can demonstrate 
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, lnclude in the other hardship section. List the grain productls) to be
exempted.

KentuckyilnoddiedSpiritcom An Equai Opportunity Employer hilFfD

 

 

Yes

Hardshipis):

List the type ef grain productis}
to be exempted and attach
Justification (picturee, recelpu,
etc. for documentation}:

 

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whale grain?rich productls} was
offered.

 



'Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich productis}.



 

Limited product availability: The does not have access to a
compliant whole grain-rich productls) in the local market and
wq?d?liite to offer enriched grain itemis} temporarily.



51' 

{amid/t5 41,4443 {Drudge

 



?acceptabie product quality: The whale grain?rich productls)

offered by the SPA did not retain the desired texture or lost

 

 

during the typical holding time.

bi 4: 
I
{re-e ear-Wei

 

 

 

Yes

Hardshiplsl:

List the type of grain productls}
to be exempted (attach
graduation record):

 



student acceptability: The whoie grain~rich productis}
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich preductisi was offered muitiple times
and over a sustained period cf time.

bis dull-.3 i
?331.4- A- (ix-?44?
{9.45er

 

 

Other hardship (please list):

 

 

 

 

List alternative proddct types/brands that have been 

 

?re

in item Product Descriptien Manufacturer

Product Code

 



QIOJMD

 

{Aj? 835mg; ?bre?g?

05/75

 

 

19.

'wa

 

 

Z. $4 72/7341?3

 

Sac/39w

 

 

Page 2 of 3

 

i"

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at least haifof the grain items offered weekly is whole grain~rich.

Sign . ture of Director of Schor?? 




 
 
 

Approved Program Manager

  

*Piease compiete this form, sign, and electronically submit to Sue Barten?eid at sue.berten?eid?ieducationxmgov

is an equal opportunity provider and employer.?

Page 3 of 3

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

. 09S doueutge 
I. as the duly authorized representative of?l?? Name], do hereby attest

that the afo mentioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products If the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productls). pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,

and must comply with the EV 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(sl to be exempted.



List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc]:

 

Financial hardship: The records demonstrate a signi?cant than in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost during the typical holdi_ng time.

 

 

Hardshipts):

List the type of grain productis) to
be exempted and attach
Justification (production records,
meal counts, student?s letters,
surveys, eth:

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-

rich productls) was offered multiple times and over a sustained period
of time.

5 en do no? alt?9
an Complatka

+Lg assets-1?6 L25-

 

 

Other hardship please list}:

P0254 weal! (Denali-?ya +091: ?che a



1 (it: ifs/11?
am! was in: II diam/g)?

N0 campLaml-s ?ier? @rea

 

 

List alternative pro s/ rands thath ve been utili ed:
3 Z: 5-0 anal? I

 

Grain Item Product Description Manufacturer

Product Code

 

sm-glxs/ few. 

 

 

 

 

Ciro/ye.) ?31! 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the tntonnahon prowcted aoove. that all
records to support the Information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

@?aL 174'?:

Signaturh of Director of School Nutrition Program Date

 



rogram Co inator Date

 

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@educatlon.ky.gov

     

'nnmd Mwnuoddo [nonmetal Silu.
It?? (E)

   



 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018?19

1, Barbara Kincaid, as the duly authorized representative of the Boone County Board of Education, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018?19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

th
a?e
rnat
ive
pro
duct

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

The district formerly served approximately
14,500 lunches daiiy prior to the meal pattern
change. We currently average less than 14,000
daily and now have 4 CEP schools which has
increased participation.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

Whole grain pasta costs 63% more than enriched pasta.

Whole grain biscuit costs 65% more than enriched flour biscuit

Cost of items:

WG pasta is 63% more than enriched pasta
51.22/36 per pound

WG Biscuits are 65% more per serving than
enriched 26 cents vs 17 cents per serving.

WG Sallines are 100% more per serving than
enriched 2 cent per W6 cracker compared to 1
cents per enriched cracker

Whole Grain are of unacceptable quality,
palata bllity and flavor.

Oyster saltine crackers are also not accepted in
the whole grain versions.

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

Saltines and oyster that maintain their
shapelslze. Whole grain versions arrived
crumbled.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain~rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

The whole grain pastas do not have
the holding quality that a good quality
enriched pasta has. Students do not
choose the pasta dish if the pasta is
whole grain.

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(sl was offered multiple times and over a sustained period
of time.

Spaghetti, biscuits, saltine/oyster
crackers,

 

 

Other hardship (please list):

 

 

types/brands that have been utilized:

 

 

My Signature Indicates that I understand and attest to the accuracy or the tntormatlon prowded above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

WW 7/9651an

Signature of Director of Schdol Nutrition Program

601 I EEK

A 44
lyrogl?am Coordiryl?' Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

Steven Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 8 500 Moro Street a Frankfort, Kentucky 40601
Phone: (502] 5644770 I: mmeducationkygov

Request for Exemption for Whole. Grain-Rich Requirements
School Years 2014-2015 and 2015?2016

i, Kim Simpson as the duly authorized representative of Bowling Green City Schoois do hereby attest that the
aforementioned SFA and all schoois under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
{Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whoie grain~rich requirement in the meal programs, in school years 2014-2015 and 2015-2016, to a schooi food
authority that demonstrates a hardship in procuring compilant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for Speci?c products if the SPA can demonstrate hardship(sl.
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the Sr 2013-2014 redoirement of at least haii of the grains offered weekiy are whole
grain?rich products.

The State Agency wiil consider hardship factors in aiiowing an exemption for the iisted whole grain-rich productls) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls} to be
exempted.

Keniu'ckyUnbridledSpirit.com An Equal Opportunity Employer MIFJD

   

UNBRIDLED SPIRIT .

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardshipls):
etc. for documentation):
Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls} was
offered. 
Financial hardship: The SFA experienced a significant cost Biscuit. WG Version costs
increase when procuring the whole grairwich productl-s). almost twice as much as
regular biscuit. invoices
Attached
Limited product availability: The SFA does not have access to a
compliant whole grain-rich produc?ds) in the local market and
would like to offer enriched grain itemls) temporarily.
Unacceptable product quality: The whole grain?rich productis)
offered by the SFA did not retain the desired texture or lost
during the typical holding time.
List the type of grain produc?s)
Yes Hardshipls): to be exempted (attach

production record):

 

Poor student acceptability: The whole grain?rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that at} records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

8-90? Eton
Signature of Director of Schools Date
5? 025/ 20/5"

Approved Program Manager Date

*Please complete this form, Sign, and electronicaily submit to Sue Bartenfield at 

is an equat opportunity provider and employer.?

Page 3 of 3

 

Steven L. Beshear Terry Holtiday, Phi).
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Ptaza Tower 500 Moro Street a Frankfort, Kentucky 40661
Phone: (502) 564-4?70 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015?2016

i, Kim Simpson as the duly authorized representative of Bowling Green City Schoois do hereby attest that the
aforementioned SFA and all schools under its turisdiction demonstrate a hardship in procuring compliant whoie grain~
rich products that are acceptable to students, and that the factors indicated in this document pose a chalieoge in
offering whole grain-rich prodects. to Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
Nationat Schoot Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whoie grate-rich requirement in the meal programs, in school years (5Y5) 2014,2015 and 2015?2016, to a schooi food
authority (SPA) that demonstrates a hardship in procuring compiiant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can 
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, browo rice, etc.) and far one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least haif of the grains offered weekly are whole
grain~rich products.

The State Agency will consider hardship factors in allowing an exemption for the iisted whole grain-rich productts-l for
the remainder of 2014-2015 and SY 2015?2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. Ifyour hardship is not listed, include in the other hardship section. List the grain producds) to be
exempted.

KentuckyUnbridledSpiritcom ?x An Equat Opportunity Empioyer MIFID

   

spree:

 

 

list the type of grain productis)

- to be exempted and attach

justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardship(s}:
etc. for documentation):
Financiai hardship: The records demonstrate a significant
drop in meai counts after the whole grain-rich productls) was
offered. . 
Financial hardship: The SFA experienced a significant cost Saitine Crackers. WG cost almost 4
increase when procuring the whoie grain-rich productls}.. times as much as regular. Bid
documentation attached
Limited product availability: The SFA does not have access to a
compiiant whoie gram?rich prodocds) in the iocai market and
would like to offer enriched grain item(s) temporarily.
Unacceptabie product quality: The whoie grain-rich productis)
offered by the SPA did not retain the desired texture or iost
during the typicai hoiding time.
List the type of grain productis)
Yes He dship(s): to be exempted (attach

production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multipie times
and over a sustained period of time.

 

 

 

Other hardship (please iist):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are availabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at ieast haif of the grain items offered weekiy is whole grain?rich.

W4- 

Sign nture of Director of Schoois Date

AU 

Approved Program Manager Date

*Piease compiete this form, sign, and eiectronicaiiy submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

 
 

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BGN 371fos?gijgog'5ggf?em

 

 

Hal Helner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital PImTower- 5003mm Street- Franidort. Kentuclty40801
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

1. Lari; Th0: CJQK as the duly authorized representative of Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonst a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an l"X" in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

'Reference: SP 32-2017
SP 33-2016

An Equal Opportunity Employer MIFID



List the type of grain productls) to
be exempted and attach
Justification (pictures, receipts,
etc. for documentation]:

(-0 

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productts) was offered.

 

Financial hardship: The SFA experienced a significant cost increase

 

L0 6 6:?me he":

   

 

 

 

 

when procuring the whole grain-rich productls). in u) it and.
at":

Limited product availability: The SFA does not have access to a 

compliant whole grain-rich productls) in the local market and would

like to offer enriched grain itemis) temporarily. I .

Preparation Hardship: Unacceptable product quality: The whole we. brScUB?s an; dart,? 

grain-rich productis) offered by the SFA did not retain the desired

Thr? ?r

 

 

 

 

texture or lost palatabillty during the typical holding time. qu- during ho }Iy_
hot 063? ELI
List the type of grain productls) to
a rdshipls) be exempted (attach production
record):
Poor student acceptability: The whole grain-rich productls) offered by Men?s Mu?? WJ
the SFA received signi?cant negative student/parent feedback or there mired?, Faro mud/1W,
do no+ lit-14h cos bis-aw!

was increased plate waste of that menu item when the whole grain-
rich productts) was offered multiple times and over a sustained period
of time.

Vial are dark-card Haw?e a

 

ease list: .
mat-06p ?Stud-'3' 9'00er I. ugorll?d 
On do. 
lift-[gimp cad-W aortacmsr
4N coil-Lush. we sea-real (M is one; a. week. mm
or? Sent-c ail/month and t+ isjmo

 

alSo Qo-npidne?? and
musi- do hair to
inA-iu Cote. ?mart:

 

 

 

 

 

 

 

 

Eta?, or [0.5 crooks. "(Reg yea} 
(yam: um mu. w-chtm . -
1? howe +m~ual Sedemids "CM?onescu?ihgd'
Listalternative Erands?tathmbeenutillzedg?an' i:
Grain Item Product Description Manufacturer Product Code
Sewiir ?st, 591.3; mg. _W_Lm?mg_?a_
Om'ggu? bane? [5 to.) a oh *5 arm 36m 
55.49 biSruH- L06 Clan. milk QierQlO 6723'"

 

 

 

 

 

. 

1'

List the type of grain productis) to
be exempted and attach
lus??w?onipIM.recelpu.

etc. for documentation):
1 1n Bic: 

 

Financial hardship: The records demonstrate a signi?cant drop In
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase *?Drmon Brae. ?03,04730 [6
when procuring the whole grain-rich productis). mind. Rica, ls ?5 [gosl? A
Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain itemis) temporarily.

Preparation Hardship: Unacceptable product quality: The whole/W? ?Guns 
grain-rich productis) offered by the SPA did not retain the desired WWM Nick. n01"

 

 

 

 

 

 

texture or lost palatabillty during the typical holdln?me. 43mgListthe type oigrain productis) to
Hardshipls): be exempted (attach production
remrd):

 

Poor student acceptability: The whole grain-rich productis) offered by ?clw?s do not Iced??u
the SPA received significant negative student/parent feedback or there (1'50. . Colo ?7 (Vlaa?r,
was increased plate waste of that menu item when the whole grain- 0rd ?8 5  a lei-air? 
rich productis) was offered multiple times and over a sustained period 4441 mans" cud (111,-in r3
Of?me- riro in +f?0?I2Li-
Other hardship (please list):
an Qpb?l 12.,er :c was as whisk Schism Gore?
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93 Swami elemommq chaff

 

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufactunr Product Code

Wen. we: (he, Rim 5l03'7l

 

 

 

 

 

 

 

 

 



bomptodmdamdr


mfordoaomdon):



 

Financial hardship: The SFA's records demonstrate a drop In
counts aftertho- wholo min-rich productts) was o?orod.

mm tome maimSJe-csheucrbam

whon products). somga is- g?k bur maze roib

TheSFAdounothavoaocosstoa
compliant whok grain-rich productts) In the local market and would

Thowhole sti-adoes naivma
grain-dob oroductts) o?orod by the SPA did not retain the dashed 990$, Wand (50:9
mx? mm 

 

 

 

 

 

 

 




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noodLes? on GCLeplfd. b4 W?am

 

 

 

 

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Mmi {065'er Manning: 61mm 

 

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records tafupport the Information are available upon request by the State Agency.

m" Qua/96y 7/94 

Signature of Director of School Nutrition Program Date

42,4244 4% 09") 
SC IM Program Coordl Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@eduoatlon.ky.gov

 

 

KennickyUnbridledSpiriLoom mg; An Equal WWerm

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
lnterim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort, Kentucky 40601
Phone: (502)564-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

i, Judy Ellis, as the duly authorized representative of Boyle County Schools, do hereby attest that the aforementioned SFA
and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant whole grain-rich
products that are accepted by students, and that the factors indicated in this document pose a challenge in offering whole
grain?rich products.

The interim ?nal rule from FMS-201741021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Biscuits and Cinnamon Rolls

KentuckyUnbridIedSpirit.com Km UNBRIDLED An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis). El

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

xx WG Biscuits

XX WG Cinnamon Rolls

 

Other hardship (please list):

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Biscuit 2 grain white biscuit Pillsbury

120851 currently in stock
(tested) New 2 gr product to
come in to warehouse fall 2018

 

Rolls Cinnamon Rolls 1.5 oz Pillsbury

 

 

 

101303 currently in stock GFS

 

 

 

 

 

 

?fly 'aucet lU Ul Lll?dl. 
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

ago 

 

 

 

 

Sign?ature of Director of School Nutrition Program Date
14 
Pro?g?ram Coordi or Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov



KentuckyUnbridtedSpintcorn cinnamon-:9 swan-y An Equal Opportunity Employer MIFID

 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Boyle County Board of Education

Name of Product a waiver is being requested for: WG Noodles

Brand Name of product used: Ultragrain Egg 34? Noodles

Recipets) in which the product is used: Soups
Chicken Paremsian Noodles

Other products tested: No other WG Noodles on bid

issues with products used and tested: WG pasts does not hold well on the sewing iine, either piain or
in prepared dishes. It becomes gummy and sticky. it has a distinct taste that is not well accepted by
students at this time.

internal Use Only

 

Date Submitted: 7A1 . 
Date Approved: 0'20) '14

JW 
Dim cite-trials had scum iSSue -no<i (MM
(9 ?4r [Dmdud? W?-tiabyet 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Boyle County Board of Education

Name of Product a waiver is being requested for: WG Rotini

Brand Name of product used: WG Dakota GrowersRotini

Recipe(s) in which the product is used: Baked Pasta Recipes
Pasta Saiad

Other products tested: No other WG Rotini on bid

issues with products used and tested: WG pasts does not hold well on the serving tine, either plain or
in prepared dishes. it becomes gummy and sticky. it has a distinct taste that is not weii accepted by
students at this time.

internal Use Only

 

Date Submitted:
Date Approved:

Approving Signature:

Outer dis-mix? how be scam wl wavy? mLinit

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Boyle County Board of Education

Name of Product a waiver is being requested for: WG Macaroni

Brand Name of product used: WG Barilla Macaroni

Recipe(s) in which the product is used: Macaroni 8: Cheese

Other products tested: WG Dakota Growers Macaroni

Issues with products used and tested: WG pasts does not hold well on the serving line, either plain or
in prepared dishes. It becomes gummy and sticky. it has a distinct taste that is not well accepted by
students at this time.

internal Use Only

 

Date Submitted: 

Date Approved: 7 ?99?l ll
Approving Signature: wW

OW olhg?if?dh 
Quwwi 



KD Prior Waiver Request for Whole Grain Rich Pasta 2014-2015

instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 - 2015.

Sponsor Name: Boyle County Board of Education

Name of Product a waiver is being requested for: we Spaghetti

Brand Name of product used: WG Dakota Spaghetti

Recipels) in which the product is used: Spaghetti with Meat sauce
Chili
Baked Pasta

Other products tested: No other WG Spaghetti on bid

issues with products used and tested: WG pasts does not hold well on the serving line, either plain or
in prepared dishes. It becomes gummy and sticky. it has a distinct taste that is not well accepted by
students at this time.

internal Use Only

 

Date Submitted:
Date Approved:

Approving Signature:

lW odW/?A We prod/MK.

w; 
?9

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

WW5 the duly authorized representative of EEaJl?hl'H' i b. Name], do hereby attest that
the aforementioned SF and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving

compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for Specific products if the SPA can demonstrate hardship(s). The
temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship
is not. listed, include in the other hardship section. List the grain product(s) to be exempted.

This institution is an equal opportunity provider.

Hardshipls):

List the type of grain product(s) to
be exempted and attach justi?cation
documentation (production records,
receipts, photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

Wh0 ? 3mm Mamet

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

Whole grain! 016W

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would like
to offer enriched grain itemlsl temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich product(s) offered by the SPA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach justi?cation
[production records, meal counts,
student's letters, surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
product(s) was offered multiple times and over a sustained period of
time.

Whole 3mm WW

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

This institution is an equal Opportunity provider.

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.



\Signatd're?of Director of Program Date 

72412;) 1/ 

Program ordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

This institution is an equal opportunity provider.

 

Steven L. Beshear Terry 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street 1: Frankfort, Kentucky-40801
Phone: (502) 564-4770 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015-2016

i, 1138 ?It ?Email i; . as the duty authorized representative of GO. SGIEEHSFA Name], do hereby attest
that the aforementioned SFA and ail schools under its jurisdiction demonstrate a hardship in procuring compiiant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agricuiture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in schooi years (SYs) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for Specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s}, pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the SY 2013-2014 requirement of at ieast half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in aliowing an exemption for the iisted whole grain?rich productis) for
the remainder of SY 2014-2015 and 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not iisted, include in the other hardship section. List the grain productis) to be
exempted.

KentuckyUnbridiedSpiritcom

   

An Equal Opportunity Employer MIFID

UNBRIDLED SPIRIT

Yes

Hardshipls):

List the type of grain productis)
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

Whom grain 
whom glain creature,

 

Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich productts). -

 

Limited product availability: The SFA does not have access to a
compiiant whole grain-rich productis) in the iocai market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich productts)
offered by the SPA did not retain the desired texture or lost
during the typical holding time.

Nholii minuscule

 

 

YES

. Hardshipis):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain~rich productis)
offered by the SPA received sigriificaet negative student/parent
feedback or there was increased plate waste of that menu item
when the whoie grain-rich productis) was offered multiple times
and over a sustained period of time

 

 

 

Other hardshi (please list):

 

 

 

 

 

a II 2606 a some ofihc ram I II
bimiipic one on one 03m )d ?so? ?giggaiig
?c?he'?l ridi H?ef?honom?nad?oag? ?01068 Legion?? E?fwu er 0'33ng
0 00
(gigg?gig hqo?ihpgl?jq Jammie) Mil hiPlrih ?ii) Gilt]S
Ici?led
List alternative product types] brands that have been utilized:
Grain item Product Description Manufacturer Product Code
biSOUii' as ammo
decide N6 creams cameo

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly Is whole grain rich.

gram/m Brights

Signatu of Directodof Schools

I I 

Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer."

8 dGi?iS hails 606 at oih?i whoa [th iodUo hOWcrar
Eric ?0 Kiwi ?1 ie not mange andeVlegaclt II

ten 0 minimum! Vi W6 ammonia
2% are {alga 043051 EAMSE anggp?mnce

Page 3 of 3

      
    

r? .
DIVISION OF SCHOOL AND ION
PRODUCTION 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11/18/2315 13:24 27a5252253
alt-?Hg, 
DIVISION OF SCHOOL AND COWTY NUTRITION 
BREAKFAST PRODUCTION RECORD WM
Menu: Biameansage?hicken PattyMini
mam - Bu?ef?aunty High Schm? Panoalxes?pples?uice Choice
gamma: Grasp: sub-nth
Oder Versus 8mm Yes
Planned StudentMenls 1?15
mums! Adah! A La Cam Meats: i/ 
Mamasmemau Sax-m1: 3 
Mama. Lana-m i?

 

 

 

 

Extra Foods - Meats not counted as a grain

Extra Fooda- Vegetablas not counted as ?ui?vegetable.
Le?overs - Rccorded in proper food component category

 

 1.- GFS Commas

 

P9991013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  
 
 
 
 
 
 
  
  
 
 
  
   
 

   
 

 

 
 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

401115 
?3093212111915? 9191141311341 9 1 919913.933 . Invoice 195911390
W'gfe'm Purchase Order
Invoice Date 08(271?2015 
115113 11178;? cw Tm
7210 1119 901943339 91111.51: COUNTY HIGH SCHOOL 116131717143511130019053911? 141912141
Ship To BUTLER COUNTY HIGH SCHOOL Bil! To BUTLER COUNTY BOARD OF EDUCATION
1147 SOUTH MAIN STREET P.0. BOX 338
MDRGANTOWN KY 42281 MORGANTOWN KY 42261 -

323; U111: 113m Description 5 [333' Unit Price- 5 
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GIFS Centraf States LLO

Page 1 of 3

 

Shbpad me Shepherdw?ia Dktn?bu?an 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. .. . .. 3426011209 Indust?al Dr Shepherdsv?te KY40185
FOOD SERVICE comm Phona?heaa?G?s-I?EGO mm? 122772224
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Invoice Date cans/2015
Hum 8229 .mm 1 I Team
721? 099 901043389 BUTLER COUNTY HIGH SCHOOL 3013572521
- 8
Ship To BUTLER COUNTY HIGH SCHOOL Bi" To BUTLER COUNTY BOARD OF EDUCATMN
I 1147 SOUTH MAIN STREET RO. BOX 339
MORGANTOWN KY 22251 MORGANTOWN KY 22261
Item . my . . Ilnveni. . 2, Extended
Coda 5 Ship; Unn- Item Dascnp?on 3 Vafua Unit Pace Price
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225251 2I-Ii?dcf I 62.1 28.28 - 132.62 
223221 22222 no: mourn P0 ?14.52 42.b50173-

 

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234. for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016- 17 All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved through school year 2016- 17 at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain- -rich

product(s) for the 2016-17 school year. This extension will be' In effect for the 2016 17 school year and

the SFA is responsible for ensuring availability of whole grain rich products to meet the 100 percent of
grains offered must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other products/brands tried in the proper columns below.

 

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain
which an Extension of Hardship, Limited Product That Have
Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptabilityg?ther) Accepted
II om lain turnout hard I II aces . i
bigot ap?deggi?u IBbolsI RIGIIS
when rain - ?nancial pharasnI'p 900i Stvd?ni
cram; 9 emit/tip I I tg

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure that at least half of the grain items offered weekly are whole grain rich.

9m tt?m) aim) RD U0 

Sighature of Diiector of Schools District D'ate

PFogram Coryr/alor Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 More Street a Frankfort, Kentucky 40801
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 

William W. Brown 
as the duly authorized representative of Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilltles related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SPA can demonstrate hardship(s). The
exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each ha consideration. if your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2015, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 5? 2017-18.

*Reference: 5P 32-2017
SP 33-2016

KenluckyUnbridledSpirit.cem An Equal Opportunity Employer 

err 

 

 

Hardship(s):

List the type of grain productfs) to
be exempted and attach
Justification (pictures, receipts,
etc. for documentation]:

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

?ammdwun?lm: 

 

Flnanciai hardship: The SFA experienced a significant cost increase -

when procuring the whole grain-rich product(sl.

 

limited product availability: The SFA does not have access to a
compliant whole grain-rich product(sl in the local market and would
like to offer enriched grain ltem(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typicai holding time.

 

W9 crackers lose mum feel and became grainy In 
Wu biscuits do not rise bake up must: mater and
are not In taste. tome, and appearance

 

Hardship(s):

List the type of grain product(s] to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(si was offered multiple times and over a sustained period
of. time.

Students do not like nor accept the wg
biscuits nor the WG crackers when
oiiered with soup and chili. Participation
has dropped and multiple parent/student
complaints have arisen.

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Cracker/saltine Crackers Saltine Zesta Keebler 01466
Biscuit Pillsbury Biscuit Dough General Mills 10084

 

 

 

 

 

 

 

 

 

 

 

My sig ture Indicates that I understand and attest to the accuracy of the information provided above that all
recorI/ information are available upon request by the State Agency.

- 6/ l/
Sign?idre ofbire?or chool Nutrition Program ?Date/

 

 

Flak/Ll

SONIMWrogfam CoordinaW Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@educaiion.ky.gov

KentuckyUnbridledSpiriLcom @1qu :y An Equal Opportunity Employer MJFID

 

 

 

Steven L. Beshear Terry Holiiday, 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF 

Capital Plaza Tower 500 Moro Street Frankfort, Kentucky 40601
Phone: (50215644770 . 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014?2015 and 2015?2016

1, William Brown, as the duly authorized representative of Caldwell County Schools Name], do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grainarich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of'Agricuiture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptable to

students.

The State Agency may approve an exemption request for specific products it the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole

grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain~rich productis} for
the remainder of Si? 2014?2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be

exempted.

KentuckyUnbridledSpidt.com An Equal Opportunity Employer 

 

 

List the type of grain product(s)
to be exempted and attach
Justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

 

Yes Hardshipls):
etc. for documentation]:
Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whole grain-rich productls) was
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productls).
Limited product availability: The SPA does not have access to a
compliant whole grain rich productls s} in the local market and
would like to offer enriched grain itemls) temporarily.

Unacceptable product quality: The whole grain rich product(s) Whole grain cracker looses mouth
offered by the SPA did not retain the desired texture or lost feet and becomes grainy in
palatability during the typical holding time soup/chill

List the type of grain product(s)
Yes to be exempted (attach
production record):
Poor student acceptability: The whole grain-rich productls) Studentswould nottakePFOdUCt

offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole graimrich productls) was offered multiple times
and over a sustained period of time.

and faced many parent complaints.
Flavor and texture very poor with
soups and chili.

 

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item

Product Description Manufacturer

Product Code

 

Cracker/seltlne

Crackers Saltine Zesta Keebler

01466

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the Information are available upon request by the State Agency, and that the SFAs receiving the exemption
must sure that at least half of the grain items offered weekly is whole grain-rich.

 

     

Approved Program Manager

 

.

 

*Please complete this form, sign, and electronically submit to Sue Bartenfleld at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort, Kentucky 40601
Phone: (502) 564-5625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

1, Pat Lane, as the duly authorized representative of Caliowav County Schools do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain prod uct(s) to be exempted.

i 
KentuckyUnbridledSpiritcom An Equal Opportunity Employer 

UNBRIDLED 

List

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich prod uct(s). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

There is not always a product in WG
form. Such as most pasta.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain?rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

WG products stick together. They are
mushy. Color turn students off.

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Students will not accept the WG
biscuit, WG Crackers, WG Pasta. They
would rather choose Pizza Line.

 

 

Other hardship (please list):

Vendors have not created a biscuit that doesn't taste sweet. Crackers
do not hold their quality. Pasta when cooking becomes clumped.
Cooks have tried several ways to prepare without any accepts from
customers (students).

 

To increase participation I switched to
regular pasta. Adding a WG roll to
make up for the WG requirement
when possible. The white biscuit is
accepted and I offer two choices of
crackers: WG and White. Let the
customer choose. It has helped my
participation

 

alternative product types/brands that have been utilized:

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Biscuit Dough 2.2 oz Pillsbury Pillsbury/General 94562-06252
meets 1.5 grain Mills

 

See Part mqe. 

 

 

 

 -- u" cm our- nun-luv? tllut Ml.

records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?Dai; 5(30i18?

 

 

 

 

Signature of Director of School Nutrition Program D5ate
64V 4? 
Program Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

 

 

 

 

 

 

 

 

Crackers Crackers White Kellogg?s/Keebler 01446 I 113836
Sunshine
Pasta - Lasagna Noodles Ribbed Lasagna 5288 A Zerega 130458
Pasta - Elbow Mac Elbow Macaroni Patria 130642
Pasta - Spaghetti Spaghetti Noodles Patria 130640

tut}? a "it
KentuckyUnbridledSpirit.com unemmzo amen-y An Equal Opportunity Employer MIFID

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability. previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary ?exibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved. through school year 2016?17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich
product(s) for the 2016?17 school year. This extension will be in effect for the 2016-17 schoolyegL and

the SFA is resgonsible for ensuring availabiliy of whole grain rich products to meet the 100 percent of
grains offered must be whole grain rich reguirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other tried in the proper columns below.

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship. Limited Product ProductsIBrands That Have

Waiver is requested. Availability. Poor Student Been Tried and Were not
Acceptability. Other) Accepted

 

'Poov Studev'?c AwTanae'Peqe?n \hlleq L06
mapped! Gm 40?: Esau??

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure that at least half of the grain items offered weekly are whole grain rich.

Dost.) 23am ?ellwguco Col?t'll?e

Sig nature of Director of Schools District Date

422%252 
rogra Coordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

3 Callounq Co . Schick
i, as the duly authorized representative of Name], do hereby attest that

the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products ifthe SFA can demonstrate hardship(s). The
temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship
is not listed, include in the other hardship section. List the grain product(s) to be exempted.

This institution is an equal opportunity provider.

List the type of grain product(s) to
be exempted and attach justi?cation

Hardship(s): documentation (production records,
receipts, photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain?rich product(s) was offered.

 

Financiai hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich prod uct(s).

Limited product availability: The SFA does not have access to a a U33. 
compliant whole grain?rich product(s) in the local market and would like BOD-9. 
to offer enriched grain item(s) temporarily. 31

Preparation Hardship: Unacceptable product quality: The whole grain-t L5 I 3 LL)
rich product(s) offered by the SFA did not retain the desired texture or Naomi; 5 C?s Sw?lb

lost palatability during the typical holding time.
Mun-R- aw? -

 

 

 

 

 

 

List the type of grain product(s) to

be exempted and attach justification
HardShiPlSli (production records, meal counts,

student?s letters, surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by WM WW
the SFA received significant negative student/ pa rent feedback or there .
. . . . [,0ng Scam-

was increased plate waste of that menu item when the whole gram-rich
product(s) was offered multiple times and over a sustained period of
time.

Other hardship (please list):

 

$an 905W "has
Mo aLOG-auohDoldo. WW ei- 
8 

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

Tortim SneeL eggiimgmianv 5582214

 

 

 

 

 

 

 

 

 

 

This institution is an equal opportunity provider.

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensur at at least half of the grain items offered weekly are whole grain rich



Signature of Director of School Nutrition Program Date

 

1A 97? 07/?/9

rogram oorc?nator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

This institution is an equal opportunity provider.

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, Each home . as the duly authorized representative of \1 FA Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain prod uctls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3







Hardship(s):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whole grain-rich productts) was


 

?Begin Sherman LO
$00.

(9

 

  

offered.
c6?

   

 

DEE.

Financial hardship: The SFA experienced a signi?cant
increase when procuring the whole grain-rich productts).

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and
would like to offer enriched grain item(s) temporarily.



 

I

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

635 ?ick-W
Quake. DP
M1

wk

 

 

Yes

Hardship(s):





List the type of grain productls)
to be exempted [attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

sweats. dc stag?
as am

 

 

 

Other hardship (please list):

 

w?

 

List alternative product types/ brands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
LOG-WM amshuw Mam heeblec W453 
Leeann we Roneqwne?i?tledl memmdi 0004*: - ewes

 

 



Sahi?a deleb Lassa Cha?ng

 

 

 

fest-Mew

 

blLiLibv li 3535b

 

@505; garagsoheboit M?t soaeciehv?o;

Page 2 of 3

&ww& MEWW sodpqm

Yes

Hardship(s):

List the type of grain produc?s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant
drop in meal counts after the whole grain-rich product(s) was
offered.



1:11.:
?a5 dd, Lasagna/j
mid: We mama

 

Financial hardship: The SFA experienced a signi?cant co
increase when procuring the whole grain?rich productls).

?cg

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain itemis) temporarily.

 

QEDEL

 

 

- Unacceptable product quality: The whole grain-rich product(s)

offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.



$5:an wwmw?

 

 

51-- Ale-wag.

 

Emu. [seller 



List the type of grain product(s)
to be exempted (attach

 

 

 

 

 

 

 

 

 

 

 

Yes Hardship(s): production record):
Poor student acceptability: The whole grain-rich ?ies
E, offered by the SPA received signi?cant negative student/parent? ?it Em
feedback or there was increased plate waste of that menu itemub-JE?L?
when the whole grain-rich product(s) was offered multiple times MSW MM
and over a sustained period of time. hegugg 
Other hardship (please list):
mm plow b04255)
List alternative product types] brands that have been utilized:
as: when while maam- (yams \aoettb
Grain Item Product Description Manufacturer Product Code
no. 085 ME
shears 1,01me qugqq 43.5!00
p0 ?1.65 [Paul-H - 130M 0
Wl??mm Handles I a 06:4;

 

 

 

 

 

 

Page 2 of 3

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

 

 

Director of Schools Dat
@mfa 5-1271?
scu/ME? Program Coordinator? Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer."

Page 3 of 3

 

Steven L. Beshear Terry Hoiliday, 
Governor . Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATEON

Capital Plaza Tower 9 500 More Street a Frankfort; Kentucky 40681
Phone: (502) 564-4770 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014~2015 and 20152016

l, Pat Lane as the duly authorized representative of Callowav County School District do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235], Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School tunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y3) 2014~2015 and 2015-2016, to a school food
authority that demonstrates a hardship in procuring compliant whole grain~rich products that are acceptable to
students. -

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls}.
The temporary exemptions are allowed for any type of grain productisi, leg, pasta, bread, brown rice, etc.) and for one
or more different products. SFAS granted an exemption must work with the State Agency to search for ariceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls} for
the remainder of 2014?2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. it your hardship is not listed, include in the other hardship section. List the grain produc?s) to be
exempted.

An Equal Opportunity Employer MIFID

 
   

oweerpceo 

 

 

 

Yes

xiist the type of grain producis)



. 

Hardshipls):

justification (pictures, receipts,
etc. for documentation):

 

YES

Financial hardship: The ?records demonstrate a significant
drop in meat counts after the whole grain~rich productls} was
offered.

Please see attached documents.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich productls}. 

 

YES

Limited product availability: The SFA does not have access to a
compliant whole grain?rich productls) in the local market and
would like to offer enriched grain itemls) temporarily.

Product using is not accepted by
the students.

 

YES

 

 

Unacceptable product quality: The whoie, grain?rich productls)
offered by the SFA did not retain the desired texture or lost
during the typicai holding time.

Student complains about texture,
color, taste and after taste.

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted [attach
production record):

 

YES

Poor student acceptability: The whole grain-rich producds}
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item

when the whole grairwich productls} was offered multiple time?? 

and over a sustained period of time.

Participation hag?fg?en drasticaily
due to theg?eiscuithd




 

 

YES

 

 

Other hardship (please list):

Availability of accepted product being on bid and accepted by
students. Due to USDA mandates some manufacturers are still
finding dif?cult to produce a product of good quality. 

My students accept the WG
Breeding, WG sandwich grains and
most other products.

 

 

List alternative product types/brands that have been 

 

 

 

Grain item Product Description Manufacturer Product Code
Biscuit Biscuit e-z Split 3? Pre baked Con Agra] Bakery it 10077
. Chef
Cracker Sunshine Harvest Mil! Wheat Kellogg?s CR5 it 11:3378

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available. upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at least half of the grain items offered weekly is wholegrain-rich.

?901i C?am . Lllalls? 

Signature of Director of Schools Date
?Res-mum. Chum Ll 3 I 15
App! ved Program, Bat . 
?ux 65/ ?0

*Please complete as form, sign, a electronically submit to Sue Bartenfleld 

   

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

 

 

 

 

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Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, new. . as the duly authorized representative of do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215,220 and 226 extends through school year 2018-19 the menu
flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s). The
temporary exemptions are allowed for any type of grain product(s), leg, pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 20134014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(sl for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration ifyour hardship
is not listed, include in the other hardship section. List the grain productls) to be exempted.

This institution is an equal opportunity provider.

Hardshipls):

List the type of grain productls) to
be exempted and attach justi?cation
documentation (production records,
receipts, photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop no
meal counts after the whole grain-rich productls) was offered-

 

Financial hardship: The SFA experienced a significant cost Increase
when procuring the whole grain-rich productls).

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would like
to offer enriched grain item(s) temporarily.

64.5 no agar,
+hnuholc. are?? lasagna,

 

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich productls) offered by the SFA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

San.? we. Crackers
Hardshiplsl: not; Gum'- a 

List the type of grain productls) to
be exempted and attach justi?cation
(production records, meal counts,
student?s letters, surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
product(s) was offered multiple times and over a sustained period of
time.

Shale-ct Padb?al? um,
Citrus-2L1 okuc.
Cultured-rt mulli-
uh?wl- gf?ukhf's.

 

 

Other hardship (please list):

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

hurled/Warts faragne GZFS



 

Cracker Creek??s 5-

.170 64?7?

 

 

 

 

 

 

 

This institution is an equal opportunity prowder.

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?455?? u/r/g?

Signature of Director of School Nutrition Program 'Date

[Bh?

 

 

Date

 

Please complete this form, Sign and electronically submit to Sandy Wagner at Sandra wagner@education ky gov

This institution is an equal opportunity provider.

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018?19

I, Lacinda Bass, as the duly authorized representative of Carlisle County Name], do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate wa'ver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

 

 

 

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s) offered by Biscuits
the SFA received significant negative student/parent feedback or there .
was increased plate waste of that menu item when the whole grain- Tort'Ha She'ls
rich product(s] was offered multipie times and over a sustained period
. crackers
of time.
Other hardship (please list):
List alternative product types! brands that have been utilized:

Grain Item Product Description Manufacturer Product Code
Biscuit Biscuit 2.2 02 easy split Pillsbury 866920
tortilla Tortilla 6 in La fronteriza 702633
cracker 4 ct zesta cracker kelloggs 270644

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy ot the Intormation proVIded above. that all
records to support the information are available upon request by the State Agency, and that the exemption must

ensu that at?alf (KM grain items offered weekly are whole grain rich
may

[Signature of Director?of Solid?ol Nutrition Program

A 50, 77F7P

SCN Program-Coy??nator Date

 

 

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra wagner@education_ky gov

 

Steven L. Beshear Terry Holiiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capitat Piaza Tower . 500 More Street . Frankfort, Kentucky 40601
Phone: (502) 564-4170 1: wweducationkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015?2016

l, Lacinda Pool, as the duiy authorized representative of Carlisle County School District, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a chailenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Pubiic Law 113-235}, Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years [SYsl 20144015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptabie to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate coiumn or columns (Yes) for each
hardship consideration. if your hardship is not listed, inciude in the other hardship section. List the grain productls) to be
exempted.

KentuckyUnbridledSpiritcom An Equal Opportunity Employer 

 
 

  

ED SPIRIT

Yes

Hardshipls):

List the type of grain productls)
to be exempted and attach
iustification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

 

Financial hardship: The experienced a significant cost
increase when procuring the whole grain-rich productis). id

 

Limited product availability: The SFA does not have accessto a
compliant whole grain-rich producds) in the local market and
would like to offer enriched grain itemls) temporarily.

Whole Grain Zesta Cracker -

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
paiata during the typical holding time.

 

Whole Grain Zesta Cracker

Whole Grain Tortiilas

 

Yes

Hardship(s):

List the type of grain productls)
to be exempted (attach
production record):

 

Poor. student acceptability: The whole grain-rich productls)
offered by the SPA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

Whole Grain Zesta Crackers

Whole Grain Tortilias

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
Tortilla Tortilla 10in 8: 8 in Tyson CRS #13912 13907
Cracker Zesta Saltine 4pk keiloggs CRS it 113836

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that at! records
to support the information are avaiiabie upon request by the State Agency, and that the SFAs receiving the exemption

mus ensure that at ie . If ofthe grain items offered weekly is whole grain?rich.
1M :1 Si 3
i of?Scho



f"
*Piease complete this for signra?t/d electronicailur submit to Sue Bartenfieid at 

   

 

 

Approved ograr?h Managerf 

is an equai opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite . Frankfort. Kentucky 40501
Phone: (502) 564-5625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

i, L60. k: (Maxi)? . as the duly authorized representative onCxW~\\ LC Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

-The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), le.g., pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products. 

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the

201849 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

mar 3 it
KentuckyUnbridledSpirii.com qugmmeo An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach 
Justification documentation
(production records, receipts,
photos, etc.):

Hardshipls):

 

 

Financial hardship: The records demonstrate a significantdrop i-n?
meal counts after the whole grain-rich product(s) was offered.

 

 

Financial hardship: The SFA experienced a significant cost increase


 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
?ag offerenriched grain itemls) temporarily. -
Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during thextypical holding time.

 

 

 

List the type of grain productis) to
be exempted and attach
Hardshipls): justification (production records,
meal counts, students letters,
surveys, eta):

 

 

Poor student acceptability: The whole grain-rich productis) offered by Le Tit. . 5 on. -. 
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list}:

 

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
tick-bk?kxu 5 
A 
.
.x

 

.3

 

List the type of grain productis) to
be exempted and attach
Justification documentation
(production records, receipts,
photos, etc.):



 

 

_Financia  hardship: The records demonstrate a signi?cant drop In
meal counts after the whole grain- -rich prod uctls) was offered.

 

 

Financial hardship: The SFA experienced a significant cost increase

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
?iers?! lestealita?litx 

 

 

 

 

 

List the type of grain productls) to
be exempted and attach
]ustlfication (production records,
meal counts, students letters,

. . surveys, etc. 

Sk??uxh tau-Q? x: :4 ts (Such k; in, "1.5 3-i- yrs- {-3.39 (cf ruli?
Poor student acceptability: The whole grain-rich productls) offered by G- .

the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period



 

 

of time.

Other hardship (please list): her-b \ck-t, Sr
dusk six-1- 453' 
Cat" 1'

 

 

 

 

 

 

 

 

 

 

 

 

 

Skh. Q..- \lei' 5. t. tux (-5 and ?keg/mks?
Listikernatlvg?pioict that have Lab?? 10:) a} 3t? 
Ch? sic-s. \bl 
Grain Item Product Description Manufacturer Product Code
*u mm s. . batsm? 
"iU-Jzn. 1H 2., ts, Vtv- L-s-w ?W's \{13?5 \Q?t )ss Q.

spooks?W- \mka-?t, won assw
we, \N?ke ?be ?It, Earn". 3 ?3
- ?5
Tq?. var; {E?nyt? $Tt? A 
{ML-urn 
brie, . bc?k'ka'r?m- vf?) 

My elgnature indicates that I understand and attest to the accuracy or the mtormatton provrded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

 

 

 

 

I .
tun; 9:3 M?k/ 2? LL 't
Sign?atur?e'of Director of School Nutrition Program Date

- 3d?

SCNIMC Program Co??nator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at 

(mic 3 it
KentuckyUnbridledSpir'i.com gimme armory An Equal Opportunity Employer MIFID

     



Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Sheila Bradshaw, as the duly authorized representative of Carter County Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018?19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

Lasagna Noodles

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Students don't accept whole grain
lasagna noodles. They become
gummy and fall apart. Appearance is
unsatisfactory as well as texture.

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Lasagna Noodle Cooked Lasagna Pasta GFS 898271
Lasagna Noodle Ridged Curly Lasagna Pasta GFS 108197

 

 

 

 

 

 

 

my Signature Indicates that I understand and attest to the accuracy or the Intorrnatlon provnded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

aka/OD?

 
   

 

 

 

 

Signatur -w-f School Nutrition Program Date 
tat/m), 492w?
Program Coordir?tor Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.kygov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Sheila Bradshaw, as the duly authorized representative of Carter County Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a

challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), le.g., pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an In the appropriate column or columns (Yes) for each hardship consideration. If your

hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drOp in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Egg Noodles

 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Students don?t accept whole grain
pasta noodles for chicken soup. They
become gummy and fall apart.
Appearance is unsatisfactory as well as
texture.

 

Other hardship [please list): 

 

 

 

List altematlve product types/brands that have been utillzed:

 

Grain item Product Description Manufacturer

Product Code

 

Egg Noodle Egg Noodle Pasta GFS

108162

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

mg/w?/m/ 

Signature of Directorgj School'Nutrition Program



SCN Progra?n't CoordinapV Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

Matthew Bevin Stephen Pruitt. 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mare Street - Frankfort. Kentucky 40601
Phone: (502) 564-4770 - 

Request for Exemption for Low-Fat Flavored Milk
For School Year 2017-18

I. 9/15 IQJWI r/jAa (J as the duly authorized representative of 6434's (gal/kg Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(ci of the Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk fat)
flavored milk through the NSLP and the SBP 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.

Documentation Submitted
(invoices, waste study,
YES Hardshipls): production records, etc.)

Si nificant decrease in milk sales since implementation of the 5

ca 4- Jar, rile i-r/

urrent meal pattern. - ,3
or ?L/rc?Sa rd ?wine/6?

 

 

Declining milk sales deSpite offering alternative products and
'brands.

 

A food waste study indicating signi?cant 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 the
palatability of fat-free, flavored milk

 

 

 

 

com r? EQUBI Opportun Emp over 

Harm 

My Signature indicates that I Understand and attest to the accuracy of the information provided above that all records to
support the information are available upon request by the State Agency.

at @917

 

     

Si g-r?lature ofE?ector of School Nutrition Program Date
I
Ap oved Program Manager Date

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer."

Page 2 of 2

Request for Exemption for Whole Grain_~Rich Requirements
School Year 2016-2017

a; it "fut-31:; in! 1 as the duty authorized representative of I Name],
do hereby attest that the aforementioned SPA and at! schoots under its jurisdiction demonstrate a hardship in procuring
cooipiiaot whole grainnrich products that are acceptabie to students, and that the factors indicated this document
pose a chailenge in offering whole grain-rich products. in Section 7'51 of the Consoiidated and Further Continuing
Appropriations Act. 2015 [Public Law Congress directed the Secretary of Agricotture to aliow State Agencies
that administer the Schoot Lunch Program (NSLP) and Schooi Breakfast Program to grant an exemption
from the reguiatory whoie grainsrich requirement in the meat programs, in school years (SYsi 2014?2015, 2015-2016 and
2016-2017 to a schooi food authority (SM) that demonstrates ahardship in procuring compiiant whoie grain-rich
products that are acceptabie to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstratehardshipts)-
The temporary exemptions are aitowed for any type of grain productls), (ego pasta. bread, brown rice. etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabie
and must compiy with the SY 201.3?2814 requirement of at feast haif of the grains offered weekty are whoie
grain?rich products.

The State Agency wili consider hardship factors in allowing an exemption for the iisted whoie productis} for SY
2016-2017. Piece an in the appropriate column or coiumns (Yes) for each hardship consideration. if your hardship is

not listed, inciode in the other hardship section. List the grain productls) to be exempted.

*Refereoce: Si? 33-2016

Page 1 of 3

Yes Hardshipis):

List the type of grain productisl
to be exempted and attach
justification (pictures, receipts,
etc. for documentation}:

 

3 Financial hardship: The records demonstrate a significant
drop in meat counts after the whoie grain-rich productis) was
offered.

 

gFinanciai hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productis).

Limited Product 

compliant whole grain rich oroductis) in the iooal market anti
woutd iike to offer enriched grain itemls )teniporariiy.

offered by the SPA did not retain the desired texture or lost;
during the typicai iioiding time.

 

Yes Hardshipis):

Unacceptabie product quaiity: The whoie grain? ?id: productisii

 

The SPA does not have access to a

1

List the type of grain productis]
to be exempted (attach
production record}:

 

Poor student acceptability: The whole grain~rich productis)
offered by the SPA received significant negative studentg?parent
5 feedback or there was increased piate waste of that menu item
when the whole grain-rich oroductis) was offered muitipie times
and over a sustained period of time.

Other hardship (please list):

Ian.? 

 

List alternative product types/brands that have been utilized: 



 

Grain Item Product Description Manufacturer

Product Code

 

. - - .. . (?at 
ff: it" ?If ?irt ?ux t' 

 

 

5-:le I. . f, if" 463154.1%; Exit5132. 5

Page 2 oi 3

My signature indicates that understand and attest to the accuracy of the information provided above, that at! records
to support the information are available upon request by the Staie Agency, and that the SFAs receiving the exemption
must ensure that at least haif of the grain items offered weekly is whoie grain?rich1.. 

 

Sign'a'ture o-fpir'ector of Schoois Da?te 

A /4 Wmm?w 33%47
Date

*Please compiete this form, Sign, and eiectronicaily submit to Sandy Wagner at 

is an equai opportunity provider and employer.?

Page 3 of 3

Wagner, Sandra - Division of School and Community Nutrition

From: . Wagner, Sandra - Division of School and Community Nutrition
Sent: Monday, May 11, 2015 2:29 PM

To: Barteniield, Sue-Nunn - Division of School and Community Nutrition
Subject: FW: WG Exemption

 

 

 

From: Bradshaw, Shelia
Sent: Monday, May 11, 2015 1:02 PM

To: Wagner, Sandra - Division of School and Community Nutrition
Subject: Re: WG Exemption

Is it possible to please reconsider my request based on the following information?

We are capable of meeting the requirement of having at least half of our grains whole grain rich. We make
our own rolls using Ultra Grain flour and all of our pizza, corn dogs, chicken nuggets, chicken patties and taco
chips/shells are whole grain rich.

I put out my own bread bid and Heiner's is the only company that will respond so this is the company we
use. Other districts using Heiner?s have also had difficulty receiving whole grain buns this SY.

Flowers is located in Lexington KY which is over 1 1/2 hours away and is the only company that will supply our
district through our co?op. lam afraid I will jump out of the frying pan into the fire by going with a bread
company located that far away. I don?t know of any local district that has ever used them.

Sheila Bradshaw

Child Nutrition Director
SNA Certi?ed Level 11
Carter County Schools
228 Carol Malone 
Grayson KY 41143
Phone 606-474?9658

Fax 606-474-6125

 

From: Wagner, Sandra Division of School and Community Nutrition
Sent: Thursday, May 7, 2015 8:31 AM

To: Bradshaw, Shelia

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition
Subject: WG Exemption

Sheiia,

We have received your request for an exemption from the whole grain rich requirements for your buns and
bread. .

It is required with an exemption that you serve at least haif of your grain products as whole grain rich
products. If your bread and buns were not whole grain we would be concerned how you would meet this requirement.

Do you procure your grain products through your co-op? Have you brought these issues up with them?

1

We think it would be in your best interest to address this issue from the procurement standpoint. You may
need to find a new vendor for grain products or address substitution issues in your bid for next year.

Exemptions when approved are temporary and it is asked that you continue to try to find acceptable whole
grain rich products even while you have an exemption.

If you would like to reapply for an exemption for other products please feel free to do so.

Please feel free to contact me if you have any questions.

Jam? Myra/6 M933 694/5

Program Coordinator

Kentucky Dept. of Education

Division of School and Community Nutriiton
(502) 564-5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and
applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion,
reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or if
all or part of an individual's income is derived from any public assistance program, or protected genetic information
in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will
apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination
Complaint Form, found online at ?ling or at any USDA office, or call
(866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the
form. Send your completed complaint form or letter to us by mail at US. Department of Agriculture, Director, Of?ce
of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 202509410, by fax (202) 690-7442 or email at
program.intake@usda.gov. 

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay
Service at (800) 8778339: or (800) 845-6136 (in Spanish).

USDA is an equal opportunity provider and employer

Wagner, Sandra Division of School and Community Nutrition

From: Wagner, Sandra Division of School and Community Nutrition
Sent: Thursday, May 07, 2015 8:31 AM

To: Bradshaw, Shelia

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition
Subject: WG Exemption

Shelia,

We have received your request for an exemption from the whole grain rich requirements for your buns and
bread.

it is still required with an exemption that you serve at least half of your grain products as whole grain rich
products. If your bread and buns were not whole grain we would be concerned how you would meet this requirement.

Do you procure your grain products through ydur? co-op? .Have you brought these issues up with them?

We think it would be in your best interest to address this issue from the procurement standpoint. You may
need to find a new vendor for grain products or address substitution issues in your bid for next year.

Exemptions, when approved, are temporary and it is asked that you continue to try to find acceptable whole
grain rich products even while you have an exemption.

if you would like to reapply for an exemption for other products, please feel free to do so.

Please feel free to contact me if you have any questions.

flung; Map/(err #9779, 

Program Coordinator

Kentucky Dept. of Education -
Division of School and Community Nutriiton
(502) 564-5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or parental status, sexual orientation, or if all or part of an individual's income is derived from any
public assistance program, or protected genetic information in employment or in any program or
activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs
and/or employment activities.)

If you wish to file a Civil Rights pr og1 am complaint of discrimination, complete the USDA Pr ogi am
Discrimination Complaint Form, found online at

filing cust. html, or at any USDA office, or call (866) 632'9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at US. Department of Agriculture,
Director, Of?ce of Adjudication, 1400 independence Avenue, S.W., Washington, DC. 202509410, by
fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 877-8339; or (800) 845-6136 (in Spanish).

USDA is an equal opportunity provider and employer

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevm
Governor

 

Stephen L. Pruitt, 
Commissioner of Education I

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, Sim-.1 L1 . as the duly authorized representative of{ iM?/g Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a dship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year 2017-18.

may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipis). The
exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or more different
products SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain?rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product[s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016.
may continue under the terms by which they were approved, through SY 2017-18.

?Referencet SP 32-2017
SP 33-2016

6mm}? 


A.
KentuckyUnbndiedSp-nt com mm marry An Equal Opportunity Employer 

Hardship(s):

 

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant drop in 

meal counts after the whole grain- -rich productls) was offered.

 

 

Financial h?ardship: The EPA experienced a significant cost increase .
when procuring the whole grain- -rich productls).

 

 

-Limited product availability: The SFA does not have access Ida-
. comp: 'iant whole grain- r-ich product(s) in the local market and would
i like to offe_r_enri_ched grain item(s) temporarily. 

 

'Preparation Hardship: Unacceptable product quality: The whole:
I grain-rich productls) offered by the SPA did not retain the desired
texture or lost during the typical holding tin_1_e.

 

#843 

 

Hardshipls):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.


A??tq/ 
Mai/.- ori?c?af

 

Other hardship (please list):

 

 

 

List alternative product typesfbrands that have been utilized:

 

i Grain Item Product Description Manufacturer

Product Code

 

MM Bier/J 0

#97474

 

?47.13 Em 

341/ 7

 

 

 

 

 

 

1500/an 3 777 3:?th air 3 7 7.3a5?mzmg?g??m i

 

My Signature Indicates that I understand and attest to the accuracy or the Information prowoecl above. that all
records to pport the information are available upon request by the State Agency.

5? 

     
 

 

 

 

 

ctoro School Nutrition Program Date
46/17? Pig-0
SCNIMC Program Coordin?or Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra wagner@educatlon ky gov

Km An Equal Opportunity Employer 

 

Steven L. Beshear Terry Holliday. 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502} 564-4770 0 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

I, Sheila Bradshaw, as the duly authorized representative of Carter County Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (SYs) 2014?2015 and 2015-2016, to a school food
authority that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpirit com An Equal Opportunity Employer 
sprang

List the type of grain product(s)
to be exempted and attach

 

 

 

 

 

 

 

 

Yes Hardship(s): justification (pictures, receipts,
etc. for documentation):
Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s). -
Limited product availability: The SFA does not have access to 3 WG Hot Dog Buns, WG Hamburger
compliant whole grain-rich product(s) in the local market and Buns and WG Sliced Bread
would like to offer enriched grain item(s) temporarily.
Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.
List the type of grain product(s)
Yes Hardship(s): to be exempted (attach

production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Hot Dog Bun Sunny Buns 12pk Heiner's 0003778
Hamburger Bun Sunny Buns 12pk Heiner?s 0003777
Sliced Bread Giant 24oz Heiner's 0003772
Sliced Bread Old Fashioned 2002 Heiner?s 0003773
Sliced Bread King 2002 Heiner?s 0006757

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

.1

 

 

 

Signature of Director of Schools Dat
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer."

Page 3 of 3

5/61'2015 bread - Bradshaw. Shelia

bread

Ellis, Debbie

.252?? AM
i . Bradshaw, Shelia 

Sheila Bradshaw

It has been very difficult to get the whole grain bread this school year. We never know what we will
receive. We have received substitutions that are sometimes smaller packages which causes a shortage of
bread. We are also required to turn in our bread order much earlier. When we do this it often results in
having too much or too little bread. it was especially hard during the winter when bad weather caused

school cancelations. We were not allowed to cancel or change the order because whole grain bread is
considered to be a Special order.
Debbie Ellis

com/owaiproiectionaspx 1i 1

5612015 Re: Whole Grain Waiver for 15-16 SY - Bradshaw. Shelia

Re: Whole Grain Waiver for 15?16 SY

Flaugher, Tempest

. 
. .. 1 ?3.4

Bradshaw, Shelia 

When you order the whole grain they would bring white bread or buns. They would say that you need to
order two weeks ahead. But sometimes still bring white.

From: Bradshaw, Shelia

Sent: Wednesday, May 6, 2015 9:26 AM

To: Skaggs, Sheila; P'Simer, Rhonda; Smith, Linda; Flaugher, Tempest; Hamilton, Bonnie; Middleton, Viola; Rice,
Kathy; Eldridge, Brenda; Ellis, Debbie; Gilliam, Jackie; Parker, Kristi

Subject: Whole Grain Waiver for 15-16 SY

Managers, I need your assistance in applying for this waiver which, if approved, would allow us to order
white buns and bread next year. I want each of you to email me a description of the difficulty you have
had receiving our whole grain bid products.

Sheila Bradshaw

Child Nutrition Director
SNA Certified Level II
Carter County Schools
325. RT and ?in!
Erik?? it? 

Phone 606-474-9658
Fax 606-474-6125



111

5/412015 Re. I need Information on the bread orders? - Bradshaw. Shelia

Re: I need information on the bread ordersll

Eldridge, Brenda

fir-'1 4 

'll
\Hl,

i5? ii?

Bradshaw, Shelia 

I received regular bread on occasion but only because my regular driver was not working and the sub did
not order whole grain far enough in advanced to get it

From: Bradshaw, Shelia

Sent: Monday, May 04, 2015 9:54 AM

To: Skaggs, Sheila; P'Simer, Rhonda; Smith, Linda; Flaugher, Tempest; Hamilton, Bonnie; Middleton, Viola; Rice,
Kathy; Eldridge, Brenda; Ellis, Debbie; Gilliam, Jackie; Parker, Kristi

Subject: I need information on the bread orders!!

I need to know if the bread company sent anything that was not whole grain or whole wheat this past
month. I cannot figure out some of the bread invoices and I need to know what they are sending and why
we couldn't get the whole grain items.

Sheila Bradshaw

Child Nutrition Director
SNA Certified Level 11
Carter County Schools
23%. 5' 'nml im' 
if"; .. 


Fax 606-474-6125

1H

5161201 5 Re' Whole Grain Waiver for 15-16 SY Bradshaw Shelia

Re: Whole Grain Waiver for 15-16 SY

Skaggs,SheHa



Bradshaw. Shelia 

We have trouble getting the full order WG. Usually some of it is always white. The days we offer a slice of
bread with the meal, some of the kids refuse it. We have asked them and there answer is we don't like
brown bread. And it is a inconvience to only be able to order on Thursdays. If there is a problem and we
need to order more WG bread or buns. Heiners can not get WG overnight.

From: Bradshaw, Shelia

Sent: Wednesday, May 6, 2015 9:26 AM

To: Skaggs, Sheila; P'Simer, Rhonda; Smith, Linda; Flaugher, Tempest; Hamilton, Bonnie; Middleton, Viola; Rice,
Kathy; Eldridge, Brenda; Ellis, Debbie; Gilliam, Jackie; Parker, Kristi

Subject: Whole Grain Waiver for 15-16 SY

Managers, I need your assistance in applying for this waiver which, if approved, would allow us to order
white buns and bread next year. i want each of you to email me a description of the difficulty you have
had receiving our whole grain bid products.

Sheila Bradshaw

Child Nutrition Director
SNA Certified Level II
Carter County Schools
32H .H?ill Klii?lr?irl?t? 


Phone 606-474?9658
Fax 606?474?6125



111

5/44'2015 Re; I need information on the bread orders!! - Bradshaw. Shelia

Re: I need information on the bread orders!!

Hamilton, Bonnie

. 21-: -- ., Ah,
.i 

?gut.

Bradshaw, Shelia 

All of my invoices are showing whole grain, but last week I did get two packages of sunny hot dog buns,
but my receipt does not show that.

From: Bradshaw, Shelia

Sent: Monday, May 4, 2015 1:54 PM

To: Skaggs, Sheila; P'Simer, Rhonda; Smith, Linda; Flaugher, Tempest; Hamilton, Bonnie; Middleton, Viola; Rice,
Kathy; Eldridge, Brenda; Ellis, Debbie; Gilliam, Jackie; Parker, Kristi

Subject: I need information on the bread orders!!

I need to know if the bread company sent anything that was not whole grain or whole wheat this past
month. I cannot figure out some of the bread invoices and I need to know what they are sending and why
we couldn't get the whole grain items.

Sheila Bradshaw

Child Nutrition Director
SNA Certified Level 11
Carter County Schools
if.? KL .irnl 
i Elli i -- 
Phone 6064746658

Fax 606-474-6125

t/t

5/6/2015 WHOLE GRAIN BREAD WAIVER - Btadshaw. Shelia

WHOLE GRAIN BREAD WAIVER

P'Simer, Rhonda



Bradshaw. Shelia 

TO WHOM IT MAY CONCERN:

WHOLE GRAIN BREAD PRODUCTS HAVE TO BE ORDERED AT LEAST A WEEK IN ADVANCE. IF OTHER FOOD
VENDORS HAVE SHORTED WHOLE GRAIN FLOURS THEN A BREAD ORDER HAS TO BE PLACED LATE. THE
LATE ORDER WILL BE WHITE BREAD OR BUNS. THERE HAVE ALSO BEEN TIMES THAT I HAVE RECIEVED
WHITE BREAD OR BUNS BECAUSE THE BAKERY RAN OUT.

Rhonda P'Simer

West Carter Middle School
Cafeteria Manager

O. Box 1510

i' .ISYHI .194.

Phone 606-286-6756
Email 

comimva/proiectionaspx

111

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Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
I Commissioner of Education I

KENTUCKY DEPARTMENT OF 

Capital Plaza Tower 0 500 Moro Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 a 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I Bath. ?nals-Jen as the duly authorized representative of ?u Harl5crv1t-[SFA Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain- -rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for speci?c products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls], pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

SCNIKDE will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017
SP 33-2016

KentuckyUanidIedSpiritcom Km UNERIDLED An Equal Opportunity Employer MIFID

List the type of grain productts) to
be and attach
justificatio (pictures, receipts,

Hardshipls):
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemts) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain productls) to
be exempted (attach production

 

 

 

 

 

 

 

 

 

Hardshipls):
record):
Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there .

. . . 5
was Increased plate waste of that menu Item when the whole grain- VIC: 
rich productls) was offered multiple times and over a sustained period
of time.

Other hardship (please list):
List alternative product types] brands that have been utilized:
Grain Item Product Description Manufacturer Product Code

but: or. 137370

 

 

 

 

 

 

 

my Signature Indicates that I understand and attest to the accuracy or me lnrorrnatlun wow. .at all
records to support the information are available upon request by the State Agency.

?it/Ks Mum?J I 

Signature of Ditector of School Nutrition Program Date

?g 3% 5 7- 
SCNI Program Coordinator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 



KentuckyUnbridledSpirit.com 
anemones: An Equal Opportunity Employer MIFID

 071'19/2013 13:26 #665 P-002
ram:

Don Parkinson

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Wayne D. Lewis
Interim Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
2 Hudson Hollow Suite Frankfort. Kentucky 40601
Phone: (502) 564-5825 0 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19
. - 914;,er .S'clac 1'

l, as the duly authorized representative o?nmq SFA Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-201743021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardshipts).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

(it 2'
KentuckyUnbridledSpirit.oom An Equal Opportunity Employer 

mama SPIRIT

From: 07/19/2018 13:27 #665 P.003

  
 
 

signature indicates that I understand and attest to the accuracy of the Information provided above. that all
re to support the information are available upon request by the State Agency. and that the exemption must
en ure that at least half of the grain items o?'e'red weekly are whole grain rich.

i9

 

irector of School Nutrition

1%

SC MMC Pr??ram Coomli?ator Date

Pldase complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

list the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc):

Hardshipls}:

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grainvrich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain itemls) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost during the typical holding time.

 

 

 

 

 

 

 

List the type of grain productls) to
i be exempted and attach

 

 

Hardshipis): justification (production records,
meal counts, students letters,
surveys, etc):
5 Poor student acceptability: The whole grain-rich productls) offered by (a 6' Bib?u?? bivde? he 07
the SFA received signi?cant negative student/parent feedback or there 1" l?ww awe; 1'0
qus 
was increased plate waste of that menu item when the whole grain- 84 in .
rich productls) was offered multiple times and over a sustained period COW '39? 5
of time.
Other hardship (please list): 50h90 I. in Fqu
. iqni 1 heat My
C9 "5 7 L5

from 

KenuickyUnbrid edSpidt.corn K01 UNMM (um;y An Equal Opportunity Employer WHO
1

 

 

 

 

From:

My

rec
en:

    
 

reof

Ec'

A A
Progi?am Coordiyf?r

07(1912018 13:27

ered weekly are whole grain rich.

tractor of School Nutrition te

 



Date

#665 P-005

signature indicates that I understandand attest to the accuracy of the information provided above, that all
ends to support the information are available upon request by the State Agency. and that the exemption must

are that at least half of the grain items



Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@educetion.ky.gov

Hardshipis):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
[production records, receipts,
photos, etc):

 

Financial hardship: The records demonstrate a signi?cant drop in
meat counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would

 

 

 

like to offer enriched grain itemls) temporarily. -
Preparation Hardship: Unacceptable product quality: The whole whole Malagasz dL't' 
grain-rich product(s) offered by the SPA did not retain the desired 3903 he? ?1?9

texture or lost palatabllity during the typical holding time.

 

{Mme com/Ll??! Calm

 

Hardship(s):

and Marc 

Ligt?hg?tyg'gofzrain product(s) to
be exempted and attach
justification (production records,
meal counts, students letters,

surveys, etc): .

 

the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
oftime.

Poor student acceptability: The whole grain-rich product(s) offered by 

{(15 d0?, Ll 
0 (H fax-lure fhl?ow

away).

 



Other hardship (please list):

Kevmfy??



 

An Equal Opportunity Employer MIFID

 

 

 

 

From: 07(191'2018 13:23 #665 P1307

My signature indicates that I understand and atlest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
en: ure that at least half of the grain items ofiEred weekly are whole grain rich.

  
 

a reof irector of School Nutrition to

44 42.. ca? 

SI: WMC_i5rogmm Coordinat? Date

   

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@educaiion.ky.gov

List the type of grain productis) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc):

Hardship(s):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis} was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productis).
Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis] in the local market and would
like to offer enriche_dgrain item(si temporarily. .. . .
Preparation Hardship: Unacceptable product quality: The whole gl?trd )5 (ill/{56
grain-rich productls) offered by the SPA did not retain the desired 47ml (1 [j 5?5 U07-
texture or lost paiatability during the typical holdingtime. 0m git-MP5
Brow/i Co to! .1
List the type of grain product(s) to
be exempted and attach
Hardshipis): justi?cation (production records,
meal counts, students letters,
surveys, etc):
Poor student acceptability: The whole grain-rich produdls) offered by 5-fuJM-f WILL M07 
the SPA received signi?cant negative student/parent feedback or there 1a Kt' vibe" ME: 
was increased plate waste of that menu item when the whole grain- .S mu.
rich productls) was offered multiple times and over a sustained period Cl 0 ?ya ,4 .
of time. 
1 Other hardship (please list):

KenmokyUnbridicdSpiriLoom may An Equal Opportunity Employer 

mm eman- .-


 

 

 

 

 

 

 

 



 

 

 

 

 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort, Kentucky 40601
Phone: (502) 564-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

1, Penny Holt, as the duly authorized representative of Christian County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FMS-201743021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013~2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.



KentuckyUnbiidiedSpiritcom spm?y An Equal Opportunity Employer 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s] was offered.



 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls). ii]

 

Limited product availability: The EPA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardshipls):

List the type of grain productis) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

 

Other hardship [please list): Pasta: Various pasta have be tried and
our participation on spaghetti has declined by about 1 to 2 on
spaghetti and other pasta serving days.

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Pasta, Spaghetti GFS 9390110837
Pasta, Linguini GFS 9390141338

 

 

 

 

 

 

 

le Slgn'dlUIl: ll I ulluclatdtlu guru causal. LU u: u: unurmauun pruwucu man um
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that least half of the grain items offered weekly are whole grain rich.

Jar/?

 

 

 

 

Signature of Dirf3ctor of School Nutrition Program Date
6" 
Program Coordinato/ Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandrawagner?educatlon kygoy

Kentucie git

KentuckyUnbridtedSpiritcom anemone spmn'y An Equal Opportunity Employer MJFID

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF 

Capital Plaza Tower 0 500 Mere Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for an Extension of Whole Grain Waiver Exemption

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113?234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under the
terms they were approved. through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in ?allowing an extension for the listed whole grain-rich product(s)
for the 2016-17 school year. This extension will be in effect for the 2016-17 school vear and the SPA is
responsible for ensuring availability of whole grain rich products to meet the 100 percent of grains offered
must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as
well as other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship, Limited Product Products/Brands That Have

Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability. Other) Accepted

 

8 Poem M: c: G, 01* 3:15: chi?l-
o"?1?r?e?i Feast Valley. to s.

 

 

 

 

 

 

 

 

 

 
    

An Equal Opportunity Employer Mil?7t)

KentuckyUnbridledSpirit.com - urveWoz. 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

mew 523-44

Signature of Director of Schools Date


Program Coonef?tor Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sanorawagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plan Tower . 500 More Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Que-c. 1" 4'
Ifsa'n?l" the duly authorized representative of Chm?g'f'fhu) Name do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an exemption request for speci?c products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

List the type of grain productis) to
be exempted and attach

Hardshipls): Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in

meal counts after the whole grain-rich productts) was offered. 

 

Financial hardship: The SFA experienced a signi?cant cost increase l/
when procuring the whole grain-rich productts).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productts) in the local market and would
like to offer enriched _grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatabllity during the typical holding time.

 

 

 

 

List the type of grain productls) to
be exempted (attach production

record)-

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was Increased plate waste of that menu item when the whole grain-
rich product(s) was offered muitlple times and over a sustained period
of time.

 

Other hardship (please list):

?chew-MW MW-



 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

I

omega? in 32 3g

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
recor to support the information are available upon request by the State Agency.

new grim

Signature of Dlrector of School Nutrition Program Date



SCM Program Coordinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

mtuck a?
yum man" An Equal Opportunity Employer MIFID

 

Steven L. Beshear Terry Holiiday, Phi).
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 More Street Frankfort, Kentucky 40601
Phone: (5.02) 5644779 a 

Request for Exemption for WholeGrain?Rich Requirements
School Years 2014~2015 and 2015-2016

i, Sandra McIntosh, as the duty authorized representative of Christian County School District do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Pubiic Law 113-235), Congress directed the Secretary of Agricuiture to ailow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whoie grain-rich requirement in the meal programs, in schooi years 2014?2015 and 2015?2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The StateAgen'cy may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptabie
products, and must comply with the SY 2013~2014 requirement of at least haif of the grains offered weekiy are whoie
grain?rich products.

The State Agency will consider hardship factors in allowing-an exemption for the listed whole grain?rich product(s) for
the remainder of SY 2014?2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, inciude in the other hardship section. List the grain product(.s) to be
exempted.

An Equai Opportunity Empioyer MIFID

 
   

manner. so SPIRIT

 

Yes 

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

yes Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich productls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich product(s). 

 

yes Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the local market and
wouid like to offer enriched grain item(s) temporarily.

Product using is not accepted by
the students

 

yes Unacceptable product quality: The whole grain-rich product(s}
offered by the SPA did not retain the desired texture or lost
paiatability during the typical holding time:

 

 

 

Students complains about color,
taste, texture and texture

 

Yes Hardship(s):

List the type of grain productts} 
to be exempted (attach
production record):

 

yes Poor student acceptability: The whole grain?rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased piate waste of that menu item
when the whole grain?rich productls) was offered multipletirnes
and over a sustained period oftime.

Participation has fallen due to the
Whoie Grain Biscuit and Crackers

 

yes Other hardship {please list):

Availability of accepted product being on bid and accepted by
the students. Due to UDSA mandates some manufacturers are
still finding it difficuit to produce a good quality product.

 

 

 

Students have accepted the Whole
Grain breeding and whole grain
sandwich grains and most other
products

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Biscuit E-Z Split 3? Pro-Baked Con Agra] Bakery CR5 ii 10077
Chef
Cracker Sunshine Harvest Mill Wheat Kellogg?s CRS ii 1114378

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the informatioh are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

get??404% Mom 7? 

Signature of Director of Schools Date
k? '5 .
?Ame @Oiomm%nw, - :11;
i

App-owed Progra Manag Date 


ease complete this form, 5i and electronicaily submitto Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

i, BeCky Lowry . as the duly authorized representative of Clark County Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate ha rdshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole

grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich prod uctis) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardshipis):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productts).

 

DDEI

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched gr_ain item(s) temporarily.

 



 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SPA did not retain the desired texture or lost

 

palatability during the typical holding time.

Peach Valley Whole Grain
Biscuit

 

Yes

HardshipIs):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Biscuit Pillsbury Southern Style Biscuit Dough Pillsbury

94562-06252

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain It offered weekly is whole grain-rich.

Becky Lowry [Ar/31g 7- 1M 3/ 12-19-16

Director of Schools Date

2; 
Program Coor nator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

 

Is an equal opportunity provider and employer.?

Page 3 of 3

nomad?
a

?36)

513300!

5

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, Melinda Nicholson, as the duly authorized representative of Clay County Public Schools District Name], do hereby
attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products.

The interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), le.g., pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain~rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich for the
2018-19 school year. Place an in the apprOpriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardship(s]:

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain'rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Whole Grain Biscuit

Whole Grain Pasta

 

 

Other hardship (please list):

Biscuit - We have served the whole grain biscuit the last two years thinking
the students would get used to the look and taste. it?s been two years and
they still won't eat the biscuits. Kitchen staff say the sausage biscuit used to
be one of the students? favorite breakfast items but they haven?t ate the
biscuits well since we changed to whole grain. See attached pictures.

Pasta - I?ve received a lot of feedback from the kitchen managers that the
students will not take the WG pasta. The food service director and food
service secretary visited an elementary school when pasta was being served
and encodraged the students to try the WG pasta. The response from several
kids was "i don?t like the brown noodles?. Several of the students would only
take the spaghetti sauce. Before the WG requirement, students really liked
the spaghetti. We would like to go back to regular pasta for the kids.

Several parents have complained regarding all the whole grain products being
served in the school breakfast and lunch program.

 

 

 

 

List alternative product types} bra that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuit Whole Grain Easy Split Biscuit Pillsbury 132268000
WG Pasta Whole Grain Rotini Barilla 1000-011-149

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
recotds to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

WW 5,71%?
Sig ature of Direct 1' of School Nutrition Program Date

Asa 6% 79%?

Coorcyaior Date

 

 

 

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@educaiion.ky.gov

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum 8933-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary flexibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship'factors in allowing an extension for the listed whole grain-rich product(s) for the
2016-17 school year This extension will be in effect for the 2016- 17 school year and the SPA is responsible for ensuring
availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 2017- 18 school year

List the grain products for which an extension is being requested and the continued hardship for consideration as weil as
other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain Products/Brands That Have Been
which an Extension of Hardship, Limited Product Availability, Tried and Were not Accepted
Waiver is requested. Other)
Enact; y'o ic? Giro??! of Sweeney 11(160 G?cmg?j .c Pth-{K .
?23} 5014+ 5km bed :13 Aim WC, Bragg
(31?0- be.? 613:,? rs 136 6362:55',
036. Ker; Odeief Pam; 71:34:59 K?occ?acb [?aw ?516 
{at-K86 hide, no 7(Mrl?e d?ccr?cinb {a wipe/? agate?),
Uclce Saree-es

 

 

 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

/%va ?ag [in [01 Mega/p

Sigfgure Director of Date

   

Program Coordi

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equalopportunity provider and employer."

Page 1 of1

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort, Kentucky 40601
Phone: (502) 554-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

Clln'l'Dn (Bush
I. I as the duly authorized representative of [13" Scam I: Name], do hereby attest
that the aforementi ned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

A

In,? 

List the type of grain product(s) to
be exempted and attach
justification documentation

Hardship(s): (production records, receipts,
photos, etc):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). El

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

Hardship(s):

 

Poor student acceptability: The whole grain-rich productls) offered by 

the SPA received signi?cant negative student/parent feedback or there Pt 1 1 0K

was increased plate waste of that menu item when the whole grain-

rich productls) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

 

 



List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation documentation

Hardshipls): (production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain- r?ich productls) in the local market and would 
like to offer enriched grain itemis} temporarily

 

Preparation Hardship: Unacceptable product quality: The whole I
grain- -rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

Hardshipis):

 

Poor student acceptability: The whole grain-rich product(s) offered by

the SPA received signi?cant negative student/parent feedback or there 3 5 uc 
was increased plate waste of that menu item when the whole grain- -

rich productls) was offered multiple times and over a sustained period M01 f. (5 
of time. .

 

Other hardship (please list):

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation documentation

Hardshipis): (production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain?rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

Hardship(s):

 

 

Poor student acceptability: The whole grain-rich productts) offered by .

the SFA received signi?cant negative student/parent feedback or there Wkg?f d.
was increased plate waste of that menu item when the whole grain? -
rich productls) was offered multiple times and over a sustained period 
of time.

Other hardship (please list):

 

 

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation documentation

Hardship(s): (production records, receipts,
photos, etc.]:

 

Financial hardship: The records demonstrate a significant drOp in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). l2]

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itern(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

Hardship(s):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there 
was increased plate waste of that menu item when the whole grain? 
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Intormatlon prowded above. that all
- to support the information are available upon request by the State Agency, and that the exemption must
that at least half - the grain items offered weekly are whole grain rich.

(maul

Date

   

 

 

Program Coordinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

see

KentuckyUnbridledSp rit?com An Equal Opportunity Employer 

 

Steven L. Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF 

Capital Plaza Tower 500 Mero Street In rankfort, Kentucky 40601
Phone: (502) 564-4??0 0 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

I, Georgia A. Rigney, F.S.D. as the duly authorized representative of Clinton County Board of Education do hereby
attest that the aforementioned SFA and ail schools under its jurisdiction demonstrate a hardship in procuring compliant
whole grain-rich products that are acceptable to students, and that the factors indicated in this document pose a
challenge in offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235}, Congress directed the Secretary of Agriculture to aliow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015-2016,
to a schooi food authority (SFA) that demonstrates a hardship in procuring compliant whoie grain-rich products that are
acceptable to students.

The State Agency may approve an exemption request for specific products ifthe SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for
the remainder of SY 2014-2015 and SY 2015?2016. Place an in the appropriate coiumn or coiumns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

KentuckyUnbridiedSpirit.com

 
 

An Equal Opportunity Employer MIFID

.

 

 

 

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardship(s):
etc. for documentation):
Financial hardship: The records demonstrate a significant Whole Grain Biscuits
drop in meai counts after the whole grain-rich product(s) was
offered. in 2011 we were using reguiar
biscuits at breakfast. The attached
edit sheets show a combined 3%
drop in participation comparing
2011 to 2014 The High Schooi is a
signi?cant drop of 13% and this was
with us pushing Breakfast for the
Month of September this year.
Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich productls). it}
Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.
Unacceptable product quality: The whole grain-rich product(s) Whole Grain Biscuit
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time. The W6 biscuits have a bad texwre
as soon as they come out of the
oven. Once they have set in the
warmer they are hard.
List the type of grain product(s)
Yes Hardship(s): to be exempted (attach
production record):
Poor student acceptability: The whole grain-rich product(s) Whole Grain Biscuit

offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whoie grain-rich product(s) was offered multiple times
and over a sustained period of time.

This is one of the biggest
complaints of our student voice
groups. We offer biscuits as a
breakfast sandwich or biscuit and
gravy 2 times each week. They take
the biscuit, throw it in the trash and
eat the meat item or eat the gravy
by itself.

 

 

 

Other hardship (please list):

 

 

Page 2 of 3

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
WGrain Crackers Kellogg Cracker Saltine Mini Kellogg 3010010088
WGraln 300-.392
Whole Wheat Westminster Whole Wheat Dot Foods Dry 30017
Crackers Cracker 300-2ct

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that ail records
to support the information are avaiiabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly IS whole grain- -rich.

1&3wu 42 I Mi

1? Director of Selig; Date

act/1,7415} a as? :75

Approved Program Manager 6 03 

 

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 4

 

 

 

Steven L. Beshear Terry Holliday. PM).
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Ptaza Tower 500 Mere Street 0 Frankfort, Kentucky 40601
Phone: {502) 564-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

I, Georgia A. Rigney, F.S.D. as the duly authorized representative of Clinton County Board of Education, do hereby
attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant
whole grain-rich products that are acceptable to students, and that the factors indicated in this document pose a
challenge in offering whole grain~rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (589) to grant an exemption
from the regulatory whole grain~rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015?2016,
to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain~rich products that are
acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptable
products, and must compty with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain product(sl to be
exempted.

KentuckyUnbridledSpiriLoom

An Equal Opportunity Employer MEFID



   

 

 

 

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardship(s):
etc. for documentation):
Financial hardship: The records demonstrate a significant
drop in meai counts after the whole grain?rich product(s) was
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).
Limited product availability: The SFA does not have access to a
compliant whole grain~rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily. 

Unacceptable product quality: The whoie grain-rich product(s) The whoie grain crackers that are
offered by the SPA did not retain the desired texture or iost available do not have an acceptable
during the typical holding time. taste or texture for the students.

We have tried the Zesta minis and
the Westminister Whole Grain
Crackers. Our salad consumptions
have dropped because the students
don?t like the crackers or the
croutons. We tried offering the
Tostito Scoops with them but they
don?t iike the Scoops with the salad.
The attached production records
indicates the drop in salad
consumptions. We do not have
salad bars in any of our schools but
offer a boxed salad as an alternate.
List the type of grain product(s)

Yes Hardship(s): to be exempted (attach
production record):

Poor student acceptability: The whole grain-rich product(s) Our student voice groups have

offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

complained about the crackers ail
yeah

 

 

 

Other hardship (please list):

 

 

Page 2 of 4

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

Grain item Product Description Manufacturer Product Code
WG Biscuit Pillsbury WG Biscuit 1.25 oz General Mills 132269000
WG E2 Split EZ Split WG Biscuit 2.51 oz General Mills 132268000
WG Biscuit Richs WG Biscuit 2.1 oz Richs 9315

 

 

 

 

 

 

My signature indicates that understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

Ari/mg// 759mm do i5;

Sig?na?ire?l Director of Sch?ols (3 Date

weave/gem :25 /5

Approved Program Manager 0 to

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Steven L. Beshear Terry 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capitai Plaza Tower 0 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 564-4770 

Request for Exemption for Whole Grainuitich Requirements
School Years 2014-2015 and 20152016

Lg?: iaH??Finlm as the duly authorized representative 01:04,le i 0.393% Name], do hereby attest

that the aforementioned SPA and ail schools under its itirisdiction demonstrate a her 5 up in procuring compliant whole
grain?rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 3?51 of the Consoiidated and Further Continuing Appropriations Act, 2015
(Pubiic Law 113?235), Congress directed the Secretary of Agricuiture to aiiow State Agencies that administer the
National School Lunch Program and Schooi Breakfast Program to grant an exemption from the reguiatoo;
whoie grain-rich requirement in the meai programs, in schooi years 2014?2015 and 2015-2016, to a school food
authority that demonstrates a hardship in procuring compiiant whole products that are acceptabie to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are aiiowed for any type of grain produc?s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the SY 2013-2014 requirement of at least half of the grains offered weekly are whoie
grain~rich products. 

The State Agency consider hardshiptactors in aiiowing an exemption for the listed whole grain-rich productls) for
the remainder of 201462015 and 2015-2016. Piece an in the appropriate coiumn or coiumns (Yes) for each
hardship consideration. it your hardship is not iisted, inciude in the other hardship section. List the grain productis) to be
exempted.

KentuckyUnoridiedSpirit.com An Opportunity Employer MERE)

   

UNBRIDLED SPIRIT

 

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
(pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whoie graimrich productis} was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich produc?s).

 



Limited product availability: The SFA does not have access to a
compiiant whoie grain~rich productis} in the iocal market and
wouid iike to offer enriched grain itemis) temporariiy,-

PWGL

9w

 



 

 

?Unacceptabie product queiity: The whole grainerich produc?s)

offered by the SPA did not retain the desired texture or lost
during the typical holding time.

at: med
Chair/9&1} li?fmd?i

which: tram titer. i-Htoia

 

 

 

Yes

Hardship(s):

on we Tet.
am Wini?gnwx eerie
List the type of grain produc?s)

to be exempted (attach
production record):

 

Poor student acceptability: The whoie grain?rich produc?s}

gathered by the SPA received significant negative student/parent

feedback or there was increased plate waste of that menu item
when the whole grain~rich productis) was offered muitiple times
and over a sustained period of time.

an?: 

Th3 km ZJ 

926,434? {Kb/6" 

 

 

 

Other hardship (piease iist):

+3146 rec :Jl?
ini- plain 0
(3le pwd/wC/?F ?1 M711

 

 

 

List aiternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

 

 

Page 2 of 3

Grain item Product Description Manufacturer Product Code Ti 
wit {c ?imm brmcir?; it?
clantEmeie/er amen mar/eter- Brto?irk for) ?rm t3 at
(?Halts Fire )7me
men" deuce Gem 906 000 33%
H. 
Clifton Chane. m?m ?it; on {no 1370001523 ?27 0

5?55 eBay/e U'mmecl?,



gut?hcir?w higsliwd?td 971M .

q-

Said (turf
?g es?dcni-s

 

 

My signature indicates that understand and attest to the aecuracy of the information provided above, that at! records
to support the information are avaiiabie upon request by the State Agency, and that the SPAS receiving the exemption

    

if; _?3o45

Sig! a ore of iirector of Date

AM ?of? 

Ag) oved Pro am jManager 
Meg/oCA/ 4i?5 
ease compietej this foray Sign, and electronically submit to Sue Barten?el at sue barten?eld@education ky gov

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016?2017

. I Tim Pa ["80 Cumberland County Schools

as the duly authorized representative of Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 753. of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whoie grain-rich requirement in the meal programs, in school years 20142015, 2015-2016 and
20162017 to a schooi food authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipis}.
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, broiyn rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabie
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekiy are whole
grain-rich products.

The State Agency consider hardship factors in ailowing an exemption for the listed whole grain-rich productis) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whoie grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compiiant whole grain-rich product(s) in the iocai market and
wouid like to offer enriched grain itemls) temporarily.

 

DEED

 

 

Unacceptable product quality: The Whole grain-rich productis)
offered by the SPA did not retain the desired texture or lost
during the typical hoiding time.

 

 

Yes

Hardship{s):

List the type ofgrain product(s)
to be exempted [attach
production record):

 

Poor student acceptability: The whole grain?rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

whole grain biscuit

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

biscuit whole grain biscuit Bakery Chef

126962

 

biscuit whole grain biscuit Pillsbury

521782

 

 

 

 

biscuit whole grain biscuit Pillsbury

 

515110

 

Page 2 of 3

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAS receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

 

  

Kirk Biggerstaff 3/16/2017
DirectorofSchoois - 
Tim Parson

3/16/2017

*Please complete this form, Sign, and electronically submit to Sandy Wagner at 

 

Program Coordinator

    

is an equal opportunity provider and employer."

Page 3 of3

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-the duly authorized representative of Name], do hereby attest that

the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a

challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
?exibilities giving the Option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s). The
temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship

is not listed, include in the other hardship section. List the grain product(s) to be exempted.

This Institution is an equal opportunity provider.

List the type of grain productls) to
be exempted and attach justi?cation

documentation {production records,
Hardshipls): yVOlo l/l 5?4

receipts, photos, etc.):

SMBAQL Conp/ AM, 

chi?i-?a- 

 

meal counts after the whole grain-rich productls) was offered.

Financial hardship: The SFA's records demonstrate a signi?cant drop in 78190,,? +5 km?KE 

 

Financial hardship: The SFA experienced a signi?cant cost increase

when procuring the whole grain-rich 

rice/ our] [6,5

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would like
to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole grain- - 
rich productls) offered by the SPA did not retain the desired texture or &l U1 

 

lost palatability during the typical holding time. t: a) 

 

 

 

Hardshipls):

List the type of grain productls) to
be exempted and attach justi?cation

36m 6/ [production records, meal counts,

student?s letters, surveys, etc.):

 

 

time.

 

Poor student acceptability: The whole grain-rich productls) offered by I @1230? {p 7:

the SFA received signi?cant negative student/parent feedback or there 
was increased plate waste of that menu item when the whole grain-rich R1 

product(s) was offered multiple times and over a sustained period of e, A) J- 

 

 

..- 

Hather hardship (please list): - 

List alternative product types/brands that have been utilized:

 

Grain Item I Product Description Manufacturer I Product Code

 

 

. u?c? 

if Qiscwiij

 

Mink [226e, 

 

 

 

 

F51 UAW iaa?kk I I 

This institution is an equal opportunity provider.

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

0930 

Signayre?yxfirector of School'?utrition Program ate

Pchf?am Coordinator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

This institution is an equal opportunity provider.

 

Steven L, Beshear Terry Hotiiday, 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF -

Gapiiat Plaza Tower . 500 More Street a Frankfort. Kentucky 40801
Phone: {502) seccrro mm.educaiion.ky.gov

Request for Exemption for Whoie Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

or) 

I, 1,ng 81' m5 as the duh,r authorized representative of :Da?i 853' Ca - SEA Name}, do herein,r attest
that the aforementioned SPA and schools under its jurisdiction demonstrate a hardship in procuring compliant whoie
grainsricli products that are acceptable to students, and that the factors indicated in this document pose a chailenge in
offering whoie graimrich products. in Section 751 of the Consolidated and Further Continuing Act, 2015
(Pubiic Law 113~235}, Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
National School Lunch Program (NSLP) and Schooi Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in thermal programs, in schooi years {S?Isl 2014-2015 and 2015-2016, to a school 
authority (SPA) that demonstrates a hardship in procuring compiiant whoie grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for Speci?c products if the SPA can oemonstrate hardship(s).
The temporary exemptions are showed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for ecceptabie
products, and must comply with the 31' 2013-2014 requirement of at feast half of the grains offered weekiy are whole
grain~rich products.

The State Agach consider hardship factors in allowing an exemption for the listed whole grain~rich productls) for
the remainder of SY 2014?2015 and SY 2015-2016. Piece an in the appropriate column or coiomns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productls} to be
exempted.

KeciuckyUnbridiedSpiritcom An Equoi Opportunity Employer WHO

   




I

List the type of grain productIs}
to be exempted and attach

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elie)

6F 11v}? 

Yes Justification (pictures, receipts,
etc. for documentation):
Financial hardship: The records demonstrate a significant uJ/g E). on 
drop in meat counts after the whole grain? rich produc?s} was 
offered (3th ?k 
Financial hardship: The SPA experienced a significant cost '7
increase when procuring the whole 1
Limited product availability: The SFA does not have aocess to a? [we] 
compiiant whote grain-rich productts) in the local market and 05/ {Mi 0" d141,?:
would tike to offereoriched grain Itemfs) temporarily. (5 .9. . at, 
Unacceptabie product quaiity: The whole gretmich productts} (It; \ab it (fer -
offered by the SFA did not retain the desired texture or test (LU (t 
paietabillw during the typical holding time. 
I 
List the type of grain producus}
Yes HardshiMs): to be exempted (attach
production record):
Poor student acceptability: The whole grain-Itch productis) it 5.60"; t?
offered by the SFA renewed significant negative studentfparent
feedback or there was increased plate waste of that menu item on
when the whole grain-rich productts) was offered multiple times pant .1 to?) 
and over a sustained period of time. 69? (k ?1
Other hardship {pieese listMantra 13?
Cw 11th 111113 #11557
. 
List-eiternetiue product types/brands that have been utlitzed:
Grain Item Product Description Manufacturer Product Code
Lone 61793-1 H- K?Ice [5.44? Roth. Mwekdu 4? ?Ade 15th 
'11 te Crete-k6?? 11.1951 1W1 at
1? Bi?scwf' 4-1 most ?21114 bf?e?cjz

 

 

 

 

 

 

Page 2 of 3



CP

My signature indicates that understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure [that at least half of the grain items offered weekly is whole grain ?rich -

??53k 

 

 

ure of Direct/r of Schools Get

zit/LU . Mb
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary flexibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whoie grain?rich product(s) for the
2016-17 school year. This extension will be in effect for the 2016-17 school year and the SEA is responsible for ensuring
availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 201748 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain Products/Brands That Have Been
which an Extension of Hardship, Limited Product Availability, Tried and Were not Accepted
Waiver is requested. Poor Student Acceptability, Other)

Alt/Sr :9 hot 

 

 

 

 

 

3,1 I?l-rnc. Crackers iLo 5! ml? 
Vs; all died a .Salacl (2 die!? in lulu/c 9mm lard" we-
pad? em \0Id flan? sat, 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records to
support the information are availabie upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

 

 

 

 

 

 

 

.7 ..
30 4
55/61?? ofDifEctorofSchoois Dat
- ?am 
SCW/M?ogf?a?m Coordinajg Date

*Please complete this form, sign, and eiectronically submit to Sandy Wagner at 

is an equai opportunity provider and employer.?

Page 1 of 1

 

I,
Steven L. Beshear Terry Hoiliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 564-4770 wumeduoatlonkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 20154016

1 ed 

l, Lise 8} m5 as the duly authorized representative of 653 CO. SEIQA Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Pregram (SBP) to grant an exemption from the regulatorx
whole grain~rich requirement in thermal programs, in school years (5Y5) 2014-2015 and 20154016, to a school foo
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products. 

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for -
the remainder of st 2014-2015 and SY 20152016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be
exempted. -

KentuckyUnbridledSpin?icom An Equal Opportunity Employer 

 

List the type of grain productis)
to be exempted and attach

 

 

 

 

 

 

 

 

 

Yes Hardshipis}: justification (pictures, receipts,
etc. for documentation):
.1 
Financial hardship: The records demonstrate a significant bO/g E) is out. i 
drop in meal counts after the whole graln~rlch productis) was ?mv}
offered. [Sf?k 6? '1 
Financial hardship: The SPA experienced a significant cost 
increase when procuring the whole grain-rich productis). -
Limited product The SFA does not have access to a {101
compliant whole grain-rich productis) In the local market and -. P, Mair of
would like to offer enriched grain itemis) temporarily. (l i" i. 
Unacceptable product quality: The whole grain-rich product(s) cub it .
offered by (the SFA did not retain the desired texture or lost (ii/U61? do?
palatabillty during the typical holding time. m5

List the type of grain productis)
Yes Hardship(s): to be exempted (attach

production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

[south



is!

[Life/i Di?
pd? 35/253)

See, Cd?h

 

 

 

 

 

 

 

Other hardship (please list): . 
a) 5 0 a; cat 6?48 c5
roe +eek 
Menu 536'
mm 
- 
. IOU) 0:7 .
List alternative product types] brands that have been utilized: 
Grain item Product Description Manufacturer Product Code

 

Lori?! grab Lyric; K?me ?ing;

af? FiriYh. 

?raisin Linaie 6M

 

Ck

 

ii

 

their) d/



 

SCitfi' 

a

 

 

62/? i4 f?dv?lcj/

 

 

Page 2 of 3





 Food-f
?Components. -

. .

a" 1,12; 
team -



 

 

egablgs?

 

 

 

 

Whole Grains
Grains

 

 

lax in: Foods Me

aisnot counted as a grain
Leftovers - Recorded in proper food component 

 

    

aiegory

 

tc: 3? CC 

 

me ol?Sclujol:
oi'Mcul: NSLP ?1511111311 
Used:
Offer Versus Serve:
Reimbursable Meals'Sn-rved:

No'narcilnhtu?sal?c Meals Servul:
. {k-Iit? 

 

 

 

 

Icon;


 

 

 

 

ilk 

cat/Meal Ait.

 

ruits

stables

 

 


read/Grams,

. gig

. .


Other-



 

Daviess County Public Schools


. onu: .
Milk ?(1mg ch-s
?g 61- *3 
6v 4? ISL-UL 
[to
?Toxic: of Fwd?



- :1 -.- - 2 Maven:

{3:   

 

a {Li

LS. CL (.5561. L.

{Th UL-
Pew?

'0 .2 

Sale: I 

Name of School:

 

 

 

AgelGroup Used:

Offer Versus Serve:

 

 

 

Reimbursabie Meals Served:

 

 

 

 

 

 

Non-reimbursable Meals Served:

 

 

Date: ee

Name of School:

ofMeal: NSLP Breakfast

Menu Plam'? A roacthro Used:

Offer Versus Serve:
Reimbursable Meals Served:

Nonareimbursable Meals Served:

. -:

Milk .

Daviess County Public Schools



Milk



61111! 
., 
ar?av?
xi?;

Frm?l?

 

 

 

2010-201 1

M- a! 

 

AUDUBON-

 

 

  

 

 

CH HIGH 30R.

 

 

Total Sarvod 8mm?;

?Tomi 5m me

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Md?mwm?i

 

 

 

 

 

Tow Some: Lunch:

 

 

 

 

'r'ml Sal-vac swam

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

blag? 'l?o egg: 

 

\pmeM-?a? ?Ol?lhchO/S? cow Mixer/e
Gratin 

2 Bi ?34" Change-m 117: tagger?4?
a? Lukrm?k 610qu90/5? we?? 173/6; QFCC 

Sc. 0:1 (?rm A ?at? Q9

 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite . Frankfort. Kentucky 40601
Phone: (50215646625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, LaDonna Bennett, as the duly authorized representative of Dawson Springs Independent School. do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring. preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FMS-201710021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section- List the grain product(s) to be exempted.

mimic g1?

KentuckyUnbridledSpir.{corn An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain productls) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). l'E

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemlsl temporarily.

There is not always a product in WG
form. Such as most pasta.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture_or lost palatability during _the typical holding time.

 

 

WG products stick together. They are I
mushy. Color turn students off.

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Students will not accept the WG
biscuit, WG Crackers, WG Pasta. They
would rather choose Pizza Line.

 

Other hardship [please list):

Vendors have not created a biscuit that doesn't taste sweet. Crackers
do not hold their quality. Pasta when cooking becomes clumped.
Cooks have tried several ways to prepare without any accepts from
customers (students).

 

 

To increase participation I switched to
regular pasta. Adding a WG roll to
make up for the WG requirement
when possible. The white biscuit is
accepted and I offer White crackers.. 
It has helped my participation

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Biscuit Dough 2.2 oz Pillsbury Pillsburnyenerai 94562-06252
meets 1.5 grain Mills
Crackers Crackers White Keilogg?s/Keebler 01446 113836
Sunshine

 

 

 

 

 

My Slgnature indicates that I understand and attest to the accuracy or the Intormatron prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.



I Erector of School Nutrition Program Date

      

 

 

Signature 0
A A Kira 
Prog'ram'Cdordingtb?ir Date

Please complete this form. sign. and e?ectronicafly submit to Sandy Wagner at Sandra.wagner@education ky gov

 

 

 

 

 

Pasta Lasagna Noodles Ribbed Lasagna 5288 A Zerega I a I $130458


Pasta Elbow Mac Elbow Macaroni Patria 130642
Pasta Spaghetti Spaghetti Noodles Patria 130640

my/L? An Equal Opportunity Employer 

anemones sprm'r

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

La Donna Bennett I Dawson Springs School Foodservice
l, . as the duly authorized representative of Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

 

 

Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich product(s).

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

Biscuits

 

List the type of grain product(s)
to be exempted (attach

 

 

 

 

 

 

 

 

 

 

 

Yes Hardship(s): production record):

Poor student acceptability: The whole grain-rich product(s) Biscuits
offered by the SPA received signi?cant negative student/parent

feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.
Other hardship (please list):

List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

LaDonna Bennett 12/05/16

Director of Schools Date

?e 

Program Coordinator Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandra.wagnerQeducationkygov.

is an equal opportunity provider and employer."

Page 3 of 3

 



stayen Beehear Terry PM). 
Governor Commissioner of Education

EBUCATIGN AND DEVELSPWIENT CAEENET
DEPARTMENT 0F EDUCATKTEN

Capital Plaza Tower a 500 More Streeto Frankfort, Kentucky 40601
Phone: (502) 5644770 mmeducationkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 203.4?2015 and 20152016

I, 6 Kat l??vt/ as the duly authorized representative of Di?o dugg??l?gh Name], do hereby attest .

that the aforementioned SPA and all schools under its jurisdiction demonstrate a hardshi- in procuring compliant whole
grain~rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory!
whole grain-rich requirement in the .meal programs, in school years 2014?2015 and 2015?2016, to a school food.
authority (SFA) that demonstrates a hardship to procuring compliant whoie products that are acceptable to

students.

The State Agency may approve an exemption request for specific products if the SEA can demonstrate hardshipis}.
The temporary exemptions are allowed for any type of grain prod uctfs), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2033u2014 requirement of at least half of the grains offered weekly are whole

grairerich products. -

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for
the remainder of Stealer?2015 and 20154016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other section. List the grain product(s) to be

exempted.

mo

An Equal Opportunity Employer MIFID

 

Yes

Hardshipis):

List the type of grain producds)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

3/1 0% 42%

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whoie grain?rich productls). -

?40m ?lers,

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich producds) in the local market and
would like to offer enriched grain itemis) temporarily.

3&0er 

 



 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SFA did not retain the desired texture or iost
paiatability during the typical holding time.

 

@dmm

 

Yes

Hardshipkz):

List the type of grain productls)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grainnrich producds) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

 

 

?1/6me Wm 2.2.31)
List alternative product types/brands that have been utilized:
Grain item Product Description Manufacturer Product Code
@oww (Zeus: What/Caged 5? 21 5?67

 

 

(mow-1t Km

9? tiff/(29%

 

 

4?

 

 

 

 

Page 2 of 3

 

 

 

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,

Yes Hardshipis):
etc. for documentation):

 

Financial hardship: The records demonstrate a significant 
drop in meal counts after the whole grain-rich productis) was Zd?] [a

offered.

 

Financial hardship: The SFA experienced a significant cost WK 
increase when procuring the whole grain-rich productis). -

 

Limited product availability: The SPA does not have access to a "2d C37 
compliant whole grain-rich productls} in the local market and
would like to offer enriched grain itemis) temporarily.

 

Unacceptable product quality: The whole grain-rich preduct(s) 
offered by the SFA did not retain the desired texture or lost 67 (W

paiatabllity during the typical holding time.

 

 

 

 

 

List the type of grain productis)
to be exempted (attach

Yes Hardshi 5):
Pl production record):

 

Poor student acceptability: The whole grain?rich productis)

offered by the SFA received significant negative student/parent

feedback or there was increased plate waste of that menu item

when the whole grain?rich produc?s) was offered multiple times
and over a sustained period of time.

 

Other hardship (please list):
WJW @?odggm 
a q% 0/4. ?out



 

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer Product Code

 

de?JQZ/km we adieu) 

 

Me 1/1161. $2613 L, @610?? (/5272.

 

 

 

 

 

 

 

Page 2 of 3

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

4K

 

Signa?/e cit Dire?ctorofSc ols Date
073mm 

 

Approved Program Manager - Date
*Please complete this form, Sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mero Street 0 Frankfort, Kentucky 40601
Phone: (502) 554-3141 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Amy Bullock, SFS Director Edmonson Co.
. as the duly authorized representative of Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32-2017
SP 33-2016

Kenz?szItk?A

KentuckyUnbridledSpirIt com ?Newman sprerry An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain productls) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation}:

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich prod uct( s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired

 

texture or lost palatability during the typical holding time.

 

Whole grain biscuits do not hold up
well when cooked and held.
Students dislike them. 

 

Hardshipls):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptabilitv: The whole grain-rich productls) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Please see copies of letters
from students at our 5th-6th
Center. 

 

Other hardship (please list):

 

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

 

I Grain item Product Description Manufacturer Product Code
2 oz. biscuit Frozen, dough Pillsbury 94562-32268
2 oz. biscuit Frozen, precooked Bakery Chef 68615121031


 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
re to support the information are available upon request by the State Agency.

?0 f/ 1 ?7

Date

     

Signa ure of Director 0 School Nutrition Program

4mm, /0 ?7?5 

Program Coq?inator Date

 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

33?

KentuckyUnbridledSpirit.com sprm?ry An Equal Opportunity Employer MIFID

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort. Kentucky 40601
Phone: (502) 564-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, Barbara Moore, as the duly authorized representative of Elliott county Board of Education, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s). The
temporary exemptions are allowed for any type of grain prod uct(s], pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. Ifyour hardship
is not listed, include in the other hardship section. List the grain product(s) to be exempted.

(uric 
KentuckyUnbridledSpin'Lcorn Keeling-o swan-y An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would like
to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich product(s) offered by the SFA did not retain the desired texture or
lost palatability during the typical holding time.

 

Saltine Crackers 8: Pasta Noodles
(spaghetti, lasagna, rotini, macaroni,
etc.)

 

Ha rdship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
product(s) was offered multiple times and over a sustained period of
time.

Saltine Crackers 8: Pasta Noodles
(spaghetti, lasagna, rotini, macaroni,
etc.)

 

 

Other hardship (please list):

 

 

 

 

My Signature indicates that I understand and attest to the accuracy ot the :ntormatlon provnded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

4 :75 aZ?/i

Signature of Director of' School Nutrition Program Date

rem/1 gee-7r

SCN/MCT?rogram Coordina?r Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

List alternative product types/ bran ds that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Crackers Mini Saltine cracker Kellogg's 522150
Pasta Spaghetti Noddles GFS 654590

 

 

 

 

 

 

All?It.

fuck a ?h
I KentuckyUnbridledSpinLcom spm?y An Equal Opportunity Employer MIFID



Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 I 

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234. for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016?17. All
temporary ?exibilities approved by a State agency under this superseded memorandum may continue under the
terms they were approved, through school year 2016-17. at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich product(s)

for the 2016-17 school year. This extension will be in effect for the 2016-17 school year and the SFA is

responsible for ensurinq availability of whole grain rich products to meet the 100 percent of grains offered
must be whole qrain rich requirement for the g017-18 school vea_r.

List the grain products for which an extension is being requested and the continued hardship for consideration as
well as other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship, Limited Product That Have

Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability. Other) Accepted

 

Biscuits Poor Student Acceptability Hamburger Hotdog Buns

 

 

 

 

 

 

 

 

 

(it 5
KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

did/U 084046,

Signature of Directbr of Schools Date



SCNIMC Program Co?n?ator Date

 

Please complete this form, sign. and electronioatly submit to Sandy Wagner at Sandra.wagner@education.kygov

 

Steven L. Beshear Terry Holiiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION 

Capital Plaza Tower 500 More Street Franldort, Kentucky 40601
Phone: (502) 5644770 0 

Request?for Exemption for Whole Grain~Rich Requirements
School Years 2014?2015 and 2015?2016

I, ianice Wagoner, as the duly authorized representative of County Board of Education, do hereby attest that the
aforementioned SPA and all schoois under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptaoie to students, and that the factors indicated in this document pose a chaiienge in
offering whoie grain-rich products. in Section 751 of the Consoiidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to aliow State Agencies that administer the
Nationai Schooi Lunch Program (NSLP) and Schooi Breakfast Program (SBP) to grant an exemption from the regulatory
whoie grain-rich requirement in the meat programs, in schooi years (SYs) 20142015 and 2015u2016, to a schooi food
authority (SFA) that demonstrates a hardship in procuring compiiant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are aliowed for any type of grain produc?ds), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must oomph; with the 2013?2014 requirement of at ieast half of the grains offered weekiy are whoie
grain~rich products.

The State Agency will consider hardship factors in ailowing an exemption for the listed whoie grain-rich produc?ds) for
the remainder of SY 2014?2015 and SY 2015-2016. Piece an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be
exempted.

KentuckyUnbridledSpiritcorn -

 

 

Yes

Hardship(s):

List the type of grain product(s}
to be exempted and attach
justification (pictures, receipts,
etc. for docu mentation):

 

Financial'hardship: The records demonstrate a significant
drop in meal counts after the whoie grain-rich produc?ds) was
offered.

Biscuits

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s). -

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the locai market and
would iike to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain?rich producds)
offered by the SFA did not retain the desired texture or lost
paiatability during the typical hoiding time.

 

 

Yes

Hardship(s}:

List the type of grain produc?s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain?rich producds)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s} was offered multiple times
and over a sustained period of time.

 

Biscuits

 

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2_ of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of. the information provided above, that at! records
to support the information are availabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at ieast haif of the grain items offered weekly is whoie grain-rich.

     

 

04/24/2015
Signature of Director Schools Date

5 6 3.0 (a
Approved Program Manager? - Date

*Please complete this form, sign, and eiectronicaiiy submit to Sue Barten?eid at 

is an equai opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
lnterim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

300 Sower Building . Frankfort. Kentucky 40601
Phone: (502) 554-3141 0 vrww.education.lty.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18


as the duly authorized representative of Name], do hereby attest
that the aforementioned SPA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ilexibilities related
to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productis], pasta. bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products.
and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain rich for the
remainder of 2015-2016 and 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. lfyour hardship is not listed, include in the other hardship section. List the grain to be exempted.

Automatic extension from SY 2016- 17'.

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29. 2016,
may continue under the terms by which they were approved. through SY 2017-18.

'Reference: 5P 32-2017
SP 33-2016

Kerr WA

u~omocco An Equal Opportunity Emptoyer MIFID

List the type of grain product(s) to
be exempted and attach

Hardshipis): justi?cation (pictures, receipts.
etc. for docume ntation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drOp in 
meal counts after the whole grainsrich product(sl was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productls}. IE

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemts) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

List the type of grain productls) to
Hardshipls): (attach production

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received signi?cant negative student/parent feedback or there

was increased plate waste of that menu item when the whole grain- $310; Jr
rich productis) was offered multiple times and over a sustained period
of time.

 

Other hardship {please list):

 

 

 

List alternative product types! brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

Bifww Rudolf/1?3 3l8?7??{

 

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy at the mtormatlon prowded above, that all
records to support the information are available upon request by the Slate Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

9mm, KWJW $1211?

?d?a?ture of School Nutrition Program

50? 

Program Coordw Date

 

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky gov

KquE/z??a?

KentuckyUnbridledSpiritcom anemone An Equal Opportunity Employer 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

300 Sower Building 0 Frankfort. Kentucky 40601
Phone: (502) 554-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18



hdf?mg?g gll?s Eh . as the duly authorized representative of Name]. do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 747 of the Act provides flexibilities related
to whole grains, sodium and flavored milk for school year (5Y1 2017-13.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain rich product(si for the
remainder of 2015-2016 and SY 2016.-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17. April 29. 2016.
may continue under the terms by which they were approved, through 2017-18.

'Reference: 5P 32-2017

SP 33-2016

enfude ?5 
corn unenroceo sen-wry An Equal Opportunty Employer 

List the type of grain productls) to
be exempted and attach
Hardship(s): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant dr0p in 7
meal counts after the whole grain-rich productls) was offered.
1

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). El

limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched Jggin ltemls) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost paiatability durinithe typical holding: time.

 

 

 

 

 



 

List the type of grain product(s) to
Hardship(s): be exempted (attach production

. cl 
Ne. @ng FUR El gr. @uwwuxc Imv clue I ig?? 4' room.
9? [Poor student acceptability: The whole grain-rich product(s) offered by i

the SPA received signi?cant negative studentfparent feedback or there at a
was increased plate waste of that menu item when the whole grain- I 

rich productls) was offered multiple times and over a sustained period 

of time. .. 

Other hardship (please list): 
We hit k.

4? r192. IDCLCIL on merit}. BUJF {Mil he?r {9 (A1319 is .
. 19? (Banal +0 whole grain . \Exb heal":


. J. . . 

 

 

list alternative product types] brands that have been utilized:

Fw? -. 

Grain Item Product Description Manufacturer Product Code

 

- 
i
i
.J.

 

 

.. .. ..

 

 

My Signature Indicates that I understand and attest to the accuracy at the rntormation protruded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

JYd/uelf; 

 

 

 

 

#?ature of Director of School Nutrition Program Date 
Jaw/l. an 
Coord?'iaw Date

Please complete this form. sign. and electronically submit to Sandy Wagner at 

Jr 
An Equal Opportunity Employer 

KentuckyUnbn?dIedSpirit.com anemone 5PM,

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mero Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017?18

Mike 88 "ee . . Etown Ind. Schools

as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpirit.com Km Um,;y An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

WG noodles and biscuits are more expensive.

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

WG noodles and Biscuits and Tortilla
shells are hard to procure. Not enough
choices

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

Please see attached from my
managers

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Please see attached from my
managers.

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Very limited.

 

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency.

 

 

Digitally signed by Mike Sallee
Mike sallee Date72017.0911 12:53 40 -o4'oo' 9/1 1/17
Signature of Director of School Nutrition Program Date

   

?734?

Date

 

rog am Coor 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

(it i 5
KentuckyUnbridledSpirit.com An Equal Opportunity Employer 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower I 500 More Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I. Cindy Whitt Fairviewlndependent

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibllities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for Specific products if the SFA can demonstrate hardshipts). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideratlon. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017?18.

?Reference: SP 32-2017
SP 33-2016

KentudtyUnbridledSpidtcom qulwm?? . An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase

when procuring the whole grain-rich product(s). 235?? Mini we ?mm 6mm? #522150 29-95

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost paiatability during the typical holdi_ng time.

 

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

record)?

 

Poor student acceptability: The whole grain-rich product(s) offered by .

the SPA received signi?cant negative student/parent feedback or there The kids throw them on the
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

share table or garbage

 

It takes two packs of Zesta Mini
WG crackers that cost .20 per
serving (229) compared to
what we would like to serve,
which would be Keebler Saltine
.10 per serving (249)

 

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain item Product Description Manufacturer Product Code

Preferred: Saltine 4ct saltine crackers 16.31 Keebler #270644
Whole grain WG Mini Crackers 29.95 Zesta #522150

 

 

 

 

 

 

 

 

 

List the type of grain productts) to
be exempted and attach

a rd shipls): Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered. amuse-mam?? emu-deem 

 

Financial hardship: The SFA experienced a signi?cant cost increase

when procuring the whole grain-rich productis). w' ?mm? 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole The whole grain pasta does not hoid
grain-rich product(s) offered by the SFA did not retain the desired good. it gets mushy. sticky and does not
texture or lost palatability during the typical holdi?g time. ?5?9 

 

 

 

 

List the type of grain productls) to
be exempted (attach production

Hardship(s): record)'

 

Poor student acceptability: The whole grain-rich productls] offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productts) was offered multiple times and over a sustained period
of time.

Our macaroni cheese
participation has dropped
almost 50% from where is was

 

Other hardship (please list): We have done just about

everything to get our kids to
eat the macaroni 8. cheese,
they use to eat it. now it's one
of our lowest taken food items

 

 

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Preferred: Pasta 20# $15.70 Kitchen Essentials #654550
Whole Grain WG Pasta 20# $27.01 Barilla #541372
51% Whole Grain 51% we Pasta 20# $15.34 Dakota Growers #229941

 

 

 

My signature indicates that I understand and attest to the accuracy of the Information provided above. that all
records to support the information are available upon request by the State Agency.



of School Nutrition Program Date

 
  
 

m/ 

Coordinator, Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov


An Equal Opportunity Employer MIFID

UNBRIMD SPIRIT

Hal Heiner

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower . 500 Moro Street - Frankfort, Kentucky 40601
Phone: (502) 554-3141 I 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
1, Chm-m Likm?r?x . as the duly authorized representative of Name], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), (egu pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns [Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition. KDE. under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

'Reference: SP 32-2017
SP 33-2016



UNERIDLED ?any An Equal Opportunity Empbyer 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain?rich product(s) was offered.

The. KS.
cap-3W
1 

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

NA cano\t Q-ramx's Jr?s
?nxoqwec m?me\

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

T?cvt. Wt ?was Rumors

somehm?s (to rum?.

weaved: 1m; ms-?wnm:

 

(1.8

 

 

Hardship(s):

Wt

?sewneck beams: 

c?recm M.
List the type of grain product(s) to

be exempted (attach production
record):

 

Poor student acceptability: The whole grain?rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Cw.- mcxe each-sawe?
eoomee. use. axe my:
aw; coaether-eosi
or 0L.

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code

?3m D\?e p. ka'?irtb a.
?r Sko?m 5c Quest Rue. 3? Vac, 6? . 3:
arm 3?1?0

 

 

 

HardshipIs):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,

etc. for documentation): 

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain?rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

mm: opt-?in wiry-tent cur-w co

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

ox. palate c5

 

3648 91-0 
camc-cd *0

6 W70 gtg?uA?i m. .84
CLLQ Qccs'ec?s no huge-hm.

 

00% We

 

Hardshipis):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

1: Kids do Yea: Rim;
toad?: ws?scx?kxM
MG- \ubsk xi-
Aeuxe mend: Lo'c??xacd?
Qasm.

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
(new 56x0 Renew ace? gf??s a; sweet
3%ch cart 3% 

 

 

 

 

 

 

 

a. c2)



my Signature Indicates that I understand and attest to the accuracy ot the tntormatton provroeo above. that all
records to support the information are available upon request by the State Agency.



(\wt 

Signatureof 06k} Ef?ch?ool Nutrition Program Date

. 7"077??77

Program nator Date 

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra wagner@education.ky gov

KenluB?%

KentuckyUnbridledSpuritcom unramoueo Emmy An Equal Opportunity Employer MIFID

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Jan Anderson, as the duly authorized representative of Fleming County Schools, do hereby attest that the aforementioned
SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant whole grain-
rich products that are accepted by students, and that the factors indicated in this document pose a challenge in offering
whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, eth and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

List the type of grain productis) to
be exempted and attach
justi?cation documentation

Hardshipls): (production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s}.

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain itemls) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach

Hardshipls): justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productis) offered by Students are not accepting the Whole 
the SPA received signi?cant negative student/parent feedback or there Grain Cinnamon Rolls well at all

was increased plate waste of that menu item when the whole grains
rich productis) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

No other grain items have been
used yet I will use a non WGR
if waiver is approved

101303 Cinnamon Rolls Pillsbury 94562-05357

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy at the intormation provided above, that all

records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain Items offered weekly are whole grain rich.

 
 
  

   

 

 

.: VA- l0/7Z!l?
re of Direc or of School Nutrition Program Date
10- 0701 ~15?
Date

 

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education kygov

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Jan Anderson, as the duly authorized representative of Fleming County Schools, do hereby attest that the aforementioned
SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing compliant whole grain-
rich products that are accepted by students, and that the factors indicated in this document pose a challenge in offering
whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardship(s): Whole Grain Rice

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos. eth:

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(sl.

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(sl temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Whole Grain Rice does not hold well.

There is not another whole grain
product like Amoy rice. which is
precooked in a bag.

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
iusti?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

 

Other hardship (please list):

-v

List

 

 

alte
rnative product types/brands that have been utilized:

 


Grain Item Product Description Manufacturer

Product Code

 

Rice Vegetable Fried Rice Amoy

 

 

 

 

61120 - 

 

 

 

 

My signature indicates that I understand and attest to the accuracy at the lnlormation provided above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

ZOI

 

ate

 

A 1/4 4/ 

SCNIlVlC??rogram Coordinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mare Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l:
l, Jan} a??m as the duly authorized representative of HS Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. In Section 747 of the Appropriations Act provides ?exibilities related
to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipisl.
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the EV 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017

SP 33-2016
I
fuck 
KentuckyUnbridIedSpidlcom An Equal Opportunity Employer MIFID
UNBRIDLED seren- .

List the type of grain product(s) to
be exempted and attach

Hardship(s): justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

list the type of grain productls) to
be exempted (attach production

Hardshipls): record):

 

Poor student acceptability: The whole grain-rich product(s) offered by 8 p13 he'll], 'Peme Pas-?la. 
the SPA received signi?cant negative student/parent feedback or there Hood Malcolm}

was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

Pm 9th +111 [(00th its a. limo (are: 4* 835?i00
?lg?dMg-eran; Dagi'a- 5'10 651:3}; Ell-n.) :D?l?a?i'a 6mm: 226"? Lil

Mama;

 

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy at the intorrnation provided above. that all
records to support the Information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

 
     


Signat@ Director of School Nutrition Program Date

    

 

Lat,? 7 

rograTnTCoordin@ Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Kmmar??tgh

- An Equal Opportunity Employer MIFID
UNBRIDLED smm-r

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mero Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, . as the duly authorized representative of ?(migdi .SgLag?slSFA Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory whole grain-
rich requirement in the meal programs, in school years (5Y5) 2014-2015, 2015-2016 and 2016-2017 to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

KentuckyUnbridiedSpirit.com Km An Equal Opportunity Employer 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Unacceptable product quality: The whole grain-rich product(s) offered
by the SFA did not retain the desired texture or lost palatability during
the typical holding time.

 

 

Peach Ual? Uliole 630-3?


 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

Grain Item Product Description Manufacturer Product Code
?Swat? ll cacti Ms 2 so: 2 .0

 

 

 

 

 

 

 

 

 

 

 

Sloas. Paige
From: 

Sent: Thursday, October 20, 2016 11:53 AM
To: Sloas, Paige
Subject: Whole Wheat

To Whom it May Concern,

The whole wheat products at Fleming County High School are not very good, and as a result, not consumed.
From the biscuits to the rolls, all whole wheat products have gained a negative reputation and our cafeteria
has as well. If this pattern persists, our school and its students will suffer.

To whom it may concern, 10/20/16

Many concerns have arose pertaining our school?s food. One major concern is surrounding the wheat
products we eat. The rolls, biscuits, bread sticks, toast, spaghetti, pancakes, and cheese sticks truly suck.
They are tasteless and remind me of sandpaper. Many students don?t eat these products and end up
throwing them away which is a waste of food and more importantly, money. Let's fix this problem by

giving us real bread that have a type of flavorll

This ?wheat problem" not only gives the food here a bad reputation, but the cafeteria as well. This isn't
fair for our hard working cooks because they simply make what is provided. If the problem isn?t fixed,
we could face serious repercussions. One in which is the fall of students eating the food here and once

again a loss of food and money.

Let's work together to get real bread back and make everyone 

Sincerely,

Student Council Member, 

Sloas, Paige

From:

Sent: Thursday, October 20, 2016 12:09 PM
To: Sloas, Paige

Subject: Student Lunch Complaints

To who it may concern, it has been brought to the Fleming County Student Councils attention that students do
not favor the new wheat buns/ biscuits and the spaghetti. Seeing that Fleming County students are considered
our customers I believe we should listen to their complaints. Lets make a change. Thank you for your time.

Sloas, Paige

From:
Sent: Thursday, October 20, 2016 12:14 PM
To: Sloas, Paige

To whom it may concern,

I believe the wheat products at the school are not very good. I believe that if it is changed more students
would eat school lunch.

To whom it may concern,

As a child growing up at Fleming County, I always looked forward to lunch. It was a
chance to see my friends and eat some really great food. My favorite meal in elementary school

was the chicken and biscuits. But it seems like ever since high school lunches aren't the same.

The foods we have now have changed dramatically since I was in elementary school. The
biscuits I used to love eating are now wheat rolls, the chicken appears to take on the properties
of fish. The chicken and biscuit aren't the only foods that have changed over the years,
spaghetti, for an example, is now watered down, in an attempt to make the food stretch for a
larger group of kids. Another issue is we have way to much breads, with every meal theres a
bread, but bread isn't good for you. I for example have ovarian which
means bread can physically hurt me. I believe there should be more options on fruits and

veggies.

I hope that my willingness to get involved will help improve our school lunches in the

future. I also hope to take what have to say in consideration.


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To whom it ma

Much of the ria's menu ha mproved in iality compa ed to last year. However, several items
remain on the that are gl I lemishes on an otherwise good menu. These items are the wheat
rolls, the whea nrakes, and th paghetti. Th 3 are by ar the most disgusting items sold.

The rolls are, a nutshell, grit' I bom'nations of wha can barely be called bread. They
taste Ilke 5 nd r! disappomtm I t. teen with tter smeared all 0 them, the taste still can?t be
masked over need to be ?l ued fro the menu and replac with another item, preferably a
regular ya ti 1 loll mad heat. cake re uch ii the same vein as the rolls. They're
tasteless a cl to be drenrh syrup to ma them bearable. spaghetti is a different beast
entirely.T no 5 are mu by have a freak similarity to the tereotypical terrible school lunch
seen in mu 0 culture.

I?m not trying off as off sive to anyone. i know our cafete ia staff have ?0 follow guidelines
for what they It not th fault and I know that they would serve us great food if no restrictions
were home of how in need some menu items are of a reform.

Sincerely,

 

To whom it may conce 

I would like to say at I do like a fair amount of the school food
here at FCHS But there are a whole lot more food that i don?t like than
I do. For example, I do i ot like the spaghetti or green beans or
everything that is whe . I was thinking about substitutions. For these
foods such as ribs, ma roni and cheese and non-wheat breads, rolls,
pancakes et things th it I really enjoy are the fried chicken, the Spicy
chicken and the Asian ticken. Please keep those three things but I
would like it if we coul substitute some other things for the other
items that 1 listed.

 

 

 



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Sloas, Paige
From: 

Sent: Thursday, October 20, 2016 12:21 PM
To: Sloas, Paige
Subject: Lunch Letter

To Whom it May Concern;

When asking students what the largest problem in their school is, they will often answer food. The food is a
huge issue with students. In fact, they often do not eat due to a lack of food they like. Without preper
nutrition, it is impossible for student achievement to take place. One large issue is the wheat bread. Wheat is
disgusting. Most students hate it. Please help rid our school of this monstrosity.

Thanks,

Student Council President

Sloas, Paige
From: 

Sent: Thursday, October 20, 2016 12:11 PM
To: Sloas, Paige
Subject: Iwish to address a concern:

To whom it may concern,

I'm confident that any cafeteria staff member is well informed about the student's opinion about the food
served. Personally, I find my options for food served to me limited as I don't favor what I'm served, especially
the wheat rolls. The lack the taste and home cooked joy that makes bread a lunch staple is gone. Spaghetti is
rather disappointing as well, as it just presents itself as the classic definition of mush. I hope that I don't come
off as offensive towards anyone but I speak from past experience.

Preferably, an alternative would be appreciated in the student body such as something that gives us
motivation on a plate. Motivation that reminds us that bread is a fun finger food once more. In contrast to
this, the Spaghetti has always been distasteful to me, landing on my plate as a ball of wet yarn. It's always
clumped together and it's not as luscious as Spaghetti should be. Spaghetti should be able to become
threaded by the fork and slurped with a i'm sorry,l haven't been smiling. My hopes have been and
still are invested into a beneficial and enjoyable lunch.

With kind regards,

 

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Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, Ph: D.
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mere Street . Frankfort, Kentucky 40601
Phone: (602) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Dale Pack 

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year 2017-18.

may approve an exemption request for Specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

d} 
com We? . An Equal Opportunity Employer 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired

 

 

texture or lost palatability during the typical holding time.

 

Hardshipls):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain?
rich productls) was offered multiple times and over a sustained period
of time.

Hamburger bun?
buns, sub buns?,

bread, and biscuits.

 

Other hardship (please list):

 

 

Students are taking the
products but they are not
eating them. They discard the
grain product after they
remove the protein/meat.

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

Buns Hamburger.?d submarine buns 

"I'm

 

- 

 

Sandwich Bread I Biscuits 

 

 

 

#2773. #231053. #269210. #565711. #237390

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all

records to support the information are available upon request by the State Agency.

WM 

 

 

 

 

Signature of Director of School Nutrition Program Date
. 4% a? 7'7 7
SCNIM Program Coordiyf?or Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentudtyUnbridledSpiriLoom

An Equai Opportunity Employer WFID

Hal Helner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY OF EDUCATION

Capital Plaza ?l'ower - 500 Mero Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 ww.education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

 _C_3hristy Pritchett . FIS

. as the duly authorized representative of -- Name], do hereby attest
thaLthe aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant-whole grain-rich products that are accepted by students, and that the factors indicated in this document

_pcse a challenge in offeriltg whole grain-rich products. Section 747 of the Appropriations Act provides ?exibillties related to
whole grains, sodium'and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grainTrich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the 2017/18
schooWe'ar. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

1?ch :3
KentuckyUnbridledSpiriLcom unemm An Equal Opportunity Employer 

 

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial records demonstrate a signi?cant drop in
. meal counts after-the whole grain-rich product(s) was offered.

 

Financial hardship: The SFAgkperienced a signi?cant cost increase
when procuring the whole 

 

Limited product availabilitv: ?The SPA does not have access .to a
compliant whole grain-rich product(s) in?the local market and would
like to offer enriched grain item(s) tern porarilv. 

 

Preparation Hardship: product quality: The whole
grain-rich product(s) offered. by the SFA did not retain the desired
texture or lost palatabilitv-Euring the typical hoidjg time.

 

WG Pasta Prpducls and
Biscuit

 

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain?rich product(s) offered by 

the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
product(s) was offered multiple times and over a sustained period
-of time.

Pasta FTroducts and

Biscuit

 

Other hardship (please 

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 



..

 

My signature indicates that! understand and attest to the accuracy of the information provided above, that all
the information are available upon request by_the State fgency.

l8] :8

 

Signature of Director of School Nutrition Program Date

Le: 

Program Coordinaw Date

Please complete this form. sign, and eiectronlcally submit to Sandy Wagner at 

fur}? ?57?
KentuckyUnbsidledSpiritcom mama?, swan-g An Equal Opportunity Employer MIFID

 





 



 

coma,

- 
0

?01'3?



Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I. mm as the duly authorized representative of CWSFA Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain prod uctls) to be exempted.

List the type of grain product(s) to
be exempted and attach
justi?cation documentation

Hardship(s): (production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability duri_ng_the typical holding time.

 

 

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):



 

 

Poor student acceptability: The whole grain-rich product(s) offered by

the SPA received signi?cant negative student/parent feedback or there 1/

was increased plate waste of that menu item when the whole grain- 

rich productts) was offered multiple times and over a sustained period ?5 Cc ?aw

of time. 6' much (2&0 hall- 
Other hardship (please list): LOMLQ gram 

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy ot the tntormatlon provrded above. that all
records to support the information are available upon request by the State ?Agency, and that the exemption must
ensure that at least If of the grain items offered weekly are whole grain rich.



Date

  
   

irector of School Nutrition Pr gram

7-4-7?

P?igram Cog??ator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

Wendy Greenwell Franklin County Public Schools
I, as the duly authorized representative of Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is

not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a signi?cant
dr0p in meal counts after the whole grain-rich product(s) was
offered.

 

 

 

Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich product(s).

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain?rich product(s)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

WG Biscuit (Peach Valley)

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(5)
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

WG Biscuit (Peach Valley)

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuit Biscuit Dough, Frozen, WG Peach Valley Bakery LLC 
WG Biscuit Biscuit, Dough, Split WG Pillsbury 32268

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

 

Wendy Greenwell 12/7/2016
Director of Schools Br?

4 {g i 
SC [MCProgram Coord' tor Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite . Frankfort, Kentucky 40501
Phone: (502) 564-5525 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

. ?1.541906
?Ariel? Margot, as the duly authorized representative off] king (00" Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Repairer/e: .r

mailman} urmumouopmcmu .3 1? nil cqum upputiuulty Llupiuycn ram 



List the type of grain product(s) to
be exempted and attach
Justification documentation
(production records, receipts,
photos, etc):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich produc?s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s). ll]

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enricheclgrain item(sl temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability duringt_he typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
rneal counts, students letters,
surveys, etc):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time

Shawl/3 old ml-
Ltilo cw accel??' H3

 

 

Other hardship (please list):

(Jim clearing H08 Mass 

0 Quit? LOO-J3 H3 ?wd?lo

Wind aj?iJV'l
goth): (in (13.09 

hobo. east-H.? LJG lpo?t keep

@Qr?w

 

1?10? LOQH 

 

List alternati product types/brands that have been ut tilized:

 

 

i

Maui 
Grain Item Product Description Manufacturer Product Code
array-guy! gone/n Gem. Ml; 0H663 gum

 

 

 

 

 

 

 

 

 

My srgnature that I understand and attest to the accuracy or the Intormatron protruded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

C31 sch/3&9 7qu 2020!?

 

 

 

 

SignatureBt?DlTeEf'or of SchdoLNutdtion Program a Date}
4% 7 3709
SCNIMC Program Date

Please complete this iorm. sign. and electronically submit to Sandy Wagner at 5andra.wagner@education.ky.gov

K911114335 3

OH 

00. afar?r wt?: 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

instructions: Submit a compieted waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

SponsorName: Fit-??71 am? 

Name of Product a waiver is being requested for: La?m Ndoc??s

Brand Name of product used: 9% 25? 0 0

01/00/50"? FMJS

Recipe(s) in which the product is used: A La: sag/yea.

Other products tested: 

Issues with products used and tested: 
N0 6 ?rm/h

internai Use Only

 

Date Submitted: 710252.121

Date Approved: 

Approving Signaturez%?/ 
No ihwmd made

 

COMM
040?

as a.
a 751 




Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Ashley Teaslev . as the duly authorized representative of Fulton Independent Schools . do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students. and that the factors indicated in this document
pose a challenge in offering whole gra-?n-rich products-

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at 'east half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost during the typical holding time.

 

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justification [production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received sign'ficant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls] was offered multiple times and over a sustained period
of time.

Whole Grain Biscuit, Brown Whole
Grain Rice

 

 

Other hardship [please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Rice Gordon Choice Parboiled Long GFS 722987
Grain Rice. 25 Lb Box. ?Case
Fiesta Rice Uncle Ben's Mexican Fiesta Rice, Uncle Ben?s 473006
25.9 Oz Box. BICase .
Biscuit Pillsbury? Frozen Biscuit Dough General Mills 1072- GFS does not have in system
Easy SplitTM Southern Style 2 5102 yet

 

 

 

 

 

 

 

 

My Signature indlcates that I underStand and attest to the accuracy or the intormatlon prowoeo above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Wu Team tag/LL
Signature of @ector of Schoowutrition Program at

Ax Key 772%)

SCNIMC Progr??m Coordin?r Date

 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky gov

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, Ashley Teosley as the duly authorized representative of Fulton Independent School, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

List the type of grain product(s) to
be exempted and attach
justi?cation documentation

Hardship(s): (production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant dr0p in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a Tornado- Whole Grain not available on
compliant whole grain-rich product(s) in the local market and would GFS
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted and attach

Hardship(s): justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

Grain item Product Description Manufacturer Product Code
Bacon Tornado WM Ruiz 149311
Maze:
Sausage Tornado Ruiz 740072
mm

 

 

 

 

 

my signature Indicates that I understand and attest to the accuracy or the Intormatlon prowded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?ilaollii
..

ate

   

 

irector of Sc 0] Nutrition Program

Am 7-3/4?

'l5ro'gram Coordinyi? Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education kygov

Request for Exemption for Whole Graini-Rich Requirements
School Year 2016-2017

1, Martha sebrmg, as the duly authorized representative of Gallatm County Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant Whole grain-rich products that are acceptabie to students, and that the factors indicated in this document
pose a chalienge in offering whole grain~rich products. In Section 751' of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, In school years (SYs) 2014-2015, 2015-2016 and
2916:2917 teessheetfeed anthem 
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are ailowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013~2014 requirement of at least haif of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for SY
2016*2017. Place an in the appropriate column or coiumns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33~2015

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain~rich product(s) was
offered.

 

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productts).

 

 

 

Limited produ?Ct availability: The SFA does not have etcess to a
compiiant whole grain-rich product(s) in the local market and

?wogldlike to offerenriched grain item(s) temporarily.

 

 

 

 

 

 

 

-- --Ueacceptable-- product quality: -- -

offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain produc?s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

i have attached a usage
report for the drop in usage
of the biscuit products

 

 

 

Other hardship (please list):

 

 

List alternative product types! brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit WG Biscuit Peach Valley Bakery 
Biscuit Mills 32268 32269

 

 

WG Biscuit

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

Mme M2919

 

 

Direclor of Schools Date
[ft/5M a? we
Program Coorgjr?i/r Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

.?TfUSDA..i.s..an .

Page 3 of 3

Don Parkinson

Secretary

Education and

.Worltforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort. Kentucky 40601
Phone: (502) 564-5625 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Martha Sebring, as the duly authorized representative of Gallatin County Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 225 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for Specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productts) to be exempted.

Iqu 37??
KentuckyUnbridledSpirit.com Emmy An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich prod uctls) was offered.

WG Pasta

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls). [fl

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

WG Pasta

 

Hardshipls):

List the type of grain prod uctls) to
be exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productts) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

WG Pasta

 

Other hardship (please list):

 

 

After Implementing the WG pasta student
dropped on the days that we
served macaroni 8: cheese and spaghetti. I
finally ended up having to take both items
off the menu. The WG pasta does not hold
well and It does not look good. Students
would not eat It and It ended up In the
trash.

 

List alternative product types/brands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Pasta Macaroni Barilla 10000013342
Pasta Spaghetti Barilla 10000013340

 

 

 

 

 

 

 

wry stgnature Indicates that I understand and attest to the accuracy or the tntormatlon promoted above, that all
records to support the Information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

(fl/7M0, Aia?/zmr. $5 5/30/90/8?

 

 

 

 

Signature of Director of School Nutrition Program Date
49/ 6130?4;
SONIMC Program Coo?inator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Karim}? 
anemone awry An Equal Opportunity Employer MIFID

COM 0104?


23

$0110

3.

1-



Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

1, Diana HClr'l' . as the duly authorized representative of (?rm Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215, 220 and 225 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain~rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
201849 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

Hardship(s]:

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

0342:] 5?7ng
(4&1on- qrea?w Ber

 

 

Other hardship (please list):

 

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
?J?lpmkuqxf "gen 6?55 I ?Mai:
'lu: l??l Win
Eve llama While?)
all-H n. J, ?4'3 0+5 .
396i {Tim-cm Uh 3201'- I (34:3

one DPW (mm

My Signature Indicates that I understand and attest to the accuracy ot the lntormation provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?ll ABM @Ll?lmi? '23
Signature of Director of School utrition Program Dat

Program Coordi?h?r Date

 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

 

. . 
I, as the duly authorized representative of (?an 3-13? Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a?hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture'to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain?rich requirement in the meal programs, in school years (8Y5) 2014-2015, 2015-2016 and
2016?2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain?rich products. -

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

QWFP. cduueb'sw 590

Page _1 of 3

List the type of grain productls)

to be exempted and attach

justification (pictures, receipts,
Yes Hardshipls): . etc. for documentation):

 

 

The srn?s records (teammate a significant
lil drop in meal counts after the whole grain-rich productis) was
offered:

 

 

hi Financial hardship?" The SFA eiperienced a significant cost
increase when procuring the whole grain-rich product(s).

 

 

Limited'p?roduct availability: The SFA does not have access to a
compliant whole grain?rich productls) in the local market and
would like to offer enriched grain itemls) temporarily.
Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
the typical holding time.

 

 

 

 

 

 

List the type of grain productls)
to be exempted (attach
Yes Hardshipls): production record):

 

 

iPoor student acceptability: The whole grain-rich productls)
offered by the SPA received significant negative student/parent

El feedback or there was increased plate waste of that menu item
i when the whole grain-rich productfs) was offered multiple times
and opera sustained period of time.

 

. Other-hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

rhumi?irain item? Description Manufacturer Product Code
. {29.59% VJM 7 ll
game: wild?re-Wi- Dank race 
?what are? ML- i? be Lila-xi? P-llebwg 9W1 'liD

 

 

Page 2 of 3

 

My signature indicates that understand and attest to the accuracy of the information provided above, that all records

to support the information are avatlabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain~rich.

JLM EL 5 mm?) ,2 iu - Pl

Director of Schools Date

    
 

   

i?rougrqamkoo?r f5 tor

W192 

Date

 

  

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Hal Hefner

Matthew G. Bevin Secretary Governor Education and

 

Workforce Development Cabinet

Stephen L. Pruitt, 
Commissioner of Education KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower Phone: (502) 564-3141 . 500 Mero Street - . Frankfort, Kentucky 40601

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Teresa NolanI FSD as the duly authorized representative of Gateway Childrens Services . do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant
whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to whole grains, sodium
and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SPA can demonstrate hardshipis). The
exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains offered
weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. lfyour hardship is not
listed, include in the other hardship section. List the grain productts) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice;
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016, may
continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpiril.com An Equal Hay/L; Opportunity Employer MIFID
SPIRIT.

JI

List the type of grain productis) to

be exempted and attach

justification (pictures, receipts,
Hardship(s). etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a Biscuits. Pancakes&French Toast
compliant whole grain-rich productis) in the local market and would Stld?s

like to offer enriched?grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich productis) offered by the SPA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to

Hardshipts): be exempted [attach production record):

 

Poor student acceptability: The whole grain-rich productls) offered by Yes
the SPA received significant negative studentfparent feedback or there
was increased plate waste of that menu item when the whole grain- rich
productls) was offered multiple times and over a sustained period

of time.

 

Whole Grain Options are not available
Other hardship (please list): from our supplier, SAL--

 

 

 

 

 

 An Equal . a. mrumy Opportunity Employer MIFID

s. UNBRIDLED SPIRIT

List the type of grain product(s) to
be exempted and attach

Hardship justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to 3 Pasta. tvpesiTDaster Pastries
compliant whole grain-rich product(s) in the local market and would

like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich product(s) offered by the SPA did not retain the desired texture or
lost during the typical holding time.

 

 

 

 

List the type of grain product(s) to

Hardship(s): be exempted (attach production record):

 

Poor student acceptability: The whole grain-rich product(s) offered by This is a Residentiai Facilitvi our kids

the SFA received signi?cant negative student/parent feedback or there have many f??d issues, ?Ch as
sensory, addiction recovery, etc. They
will not eat whole wheat pasta because
product(s) was offered multiple times and over a sustained period ofthe texture unless it is mixed in with

other 

was increased plate waste of that menu item when the whole grain- rich

of time.

 

We have one grocery source, a local
Other hardship (please list): store, Save a Lot.-

 

 

 

 

 

 Pl typcaf unmiua ll 

 

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuits Grands Buttermilk Biscuits Pillsbury 1800085516
Pancakes Buttermilk Pancakes Morning Delight 05193301640
French Toast Frozen French toast sticks Americas Choice 5193301620
Sticks

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency.

1 155;?) 09/05/2010

Signature of Director of School Nutrition Program Date

4 (Ar? 417/7?

SCN7MC Program Co?d?rhator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.goy

 

 

Matthew Bevin 

Governor

Stephen Pruitt, 
Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET DEPARTMENT OF EDUCATION

Capital Plaza TPhone: (502) 564-4770 ower - 500 Mero Street - - Frankfort, Kentucky 40601

Request for Exemption for Low-Fat Flavored Milk

For School Year 2017-18

I, __Teresa Nolan, as the duly authorized representative of _Gateway Childrens Services_, do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship clue to a decline in milk sales or
increased milk waste. Under Section 747(c) of the Appropriations Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk fat)
flavored milk through the NSLP and the SBP 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

Ves

or an increase in school milk waste.

Hardship(s):

Significant decrease in milk sales since implementation of the?

current meal pattern.

 

Declining milk sales despite offering alternative products and
brands.

A food waste study indicating signi?cant waste of fluid milk.

 

Significant negative feedback from stud-ants and parents
regarding lack of availability of low-fat, flavored milk

Documentation Submitted
(invoices, waste study,
production records, etc.)

 

 

Signi?cant negative feedback from students regarding the

 

palatability of fat-free, flavored milk.

 

 

KentuckyUnbridledSpirit.corn An Equal Opportunity Employer MIFID

UNERIDLED SPIRIT 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency.

kit/Leona F51) ?7

Date
?7
Dateq'?/ 

*Please complete this form, Sign, and electronically submit to Sandy Wagner at Sandra.Wagner@education.ky.gov

 

is an equal opportunity provider and employer.?

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

Gatewa' Childrens Services
I, Te resa as the duly authorized representative of Name],

do hereby attest that the aforementioned SPA and ail schoois under its Jurisdiction demonstrate a hardship in procuring
compliant whole grain?rich products that are acceptabie to students, and that the factors indicated in this document
pose a chaiienge in offering whoie grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture to aliow State Agencies
that administer the Nationai Schooi Lunch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whoie grain?rich requirement in the meal programs. in school years (3Y5) 2014?2015, 2015-2016 and
2016-2017 to a schooi food authority (SPA) that demonstrates a hardship in procuring compliant whole grain~rich
products that are acceptable to students. .

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SN 2013~2014 requirement of at least haif of the grains offered weekly are whole
grain-rich products. -

The State Agency will consider hardship factors in ailowing an exemption for the iisted whole grain?rich product(s) for SY
2016~2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is

not listed, include In the other hardship section. List the grain productls) to be exempted.

*Reference: SP 334016

Page 1 of 3

 







Hardshipls):

List the type of grain 
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole graimich productis) was
offered.

 

CID

Financiai hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich producds).

 



Limited product availability: The SFA does not have access to a
compliant whoie grain?rich productis) in the local market and
would iike to offer enriched grain itt?ds) temporarily.

Biscuits. Toaster pastries, French
Toast Sticks, Cinnamon Rolls

 



 

 

Unacceptable product quality: The whole grain~rich product(s)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

Yes

Hardshipis}:

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SEA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please iist):

 

We only have one local
grocerystore option. Save
A Lo, that isw willing to
deliver, we have less than
30 students so delivery
from GFS is not available.

 

List alternative product types/brands that have been utilized:

 

Grain item

Product Description Manufacturer

Product'Code

 



frozen buttermilk biscuit

premium pick 5 

5193333968

 

tench toast sticks

frozen 110 gr sticks Americas?Choice

5193301620

 

 

cinnamon rolls

 

 

8 cinn. rolls w/icing morning delight

 

5193301600

 

Page 2 of 3

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above; that all records

to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

 

 

Joe Gomes, CEO A 4/3/2017
Director of Schools Date
Teresa Nolan, F8 ans/2017
Program Coordinator #7077637

*Pleese complete this form, Sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Request for Exemption for Whole Grain Rich Requirements
School Year 2016? 2017

1 Teresa Gateway Childrens Services

as the duiy authorized representative of Name],
do hereby attest that the aforementioned SPA and ail schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain? ?rich products that are acceptabie to students, and that the factors indicated in this document
pose a challenge in offering whole grain- -rich products in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113? ?,235) Cengress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the most programs, in school years (SYsi 20144015, 2015-2016 and
2016?20i7 to a school food authority (SFA) that demonstrates a hardship in procuring compiiant whole grein~rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate herdshipis).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabie
products, and must comply with the SY 2013-2014 requirement of at ieast half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Piece an in the apprOpriate column or columns (Yes) for each hardship consideration. if your hardship is

not listed, include in the other hardship section. List the grain productis) to be exempted.

*Reference: SP 33-2016

Page 1 of 3



(D



Hardshipis):

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich produotls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whoie grain-rich productis).

 

EDD

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productis) in the locai market and
would like to offer enriched grain itemis) temporarily.

Pasta, All Types. Toaster
pastries

 



 

 

Unacceptable product quality: The whoie grain-?rich productis)
offered by the SFA did not retain the desired texture or lost
during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SPA received significant negative studee-t/parent
feedback or there was increased plate waste of that menu item
when the whoie grain~rlch productis) was offered multipie times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List aiternatiue product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Pasta Spaghetti Mantia's

5193310620

 

Pasta Egg Noodles Mantia's

5193310550

 

 

 

 

toaster Pastries enriched wheat iiour toaster pastries Kig i 

 

5193332845

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy offtte information provided above, that ail records
to support the information are available upon request by the State Agency, and that the EMS receiving the exemption
must ensure that at least haif of the grain items offered weekly is whole grain?rich.

Joe Gomes,CEO A 4/3/17

Director of Schools Date

Teresa Nolan, F8 4/3/17
y70 

Program Coordinator Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandro.wagner?ieducationkvgov.

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

I
'11
oz



Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

Stacy Jessie_, as the duly authorized representative of _Glasgow Independent Schools_, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s} to be exempted.

List

Hardshiplsi:

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost during the typical holding time.

 

 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Students throughout the district
continue to complain about the whole
grain biscuits. Students are either not
taking the breakfast biscuits OR are

ta king them and only eating the meat
or egg and throwing away the biscuit.

 

 

Other hardship (please list):

 

 

alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

?over the past three years we have tried a
variety of whole grain biscuits. None have
been considered satisfactory to the
students we serve

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the lntormatlon prowoed above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

HM

Signature of Director fSchool Nutrition Program Date

 

8" 

Date

 

 

 

 

 

 

COM
. 

J-
2

?8
?fore.?

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, _Kathy Craven as the duly authorized representative of _Grant County Schools Food Service
Department Name], do hereby attest that the aforementioned SFA and all schools under its
jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant whole grain-rich products that are
accepted by students, and that the factors indicated in this document pose a challenge in offering whole grain-rich
products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-20141 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemts) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palata bility during the typical holding time.

 

 

WG Biscuits

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Biscuits

 

Other hardship (please list):

Nutritionals in the whole grain product are higher in calories,
saturated fat and carbs.

 

 

WG Biscuits

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Sliders WG Slider buns Klostermans

 

 

 

 

 

 

 

 

 

List

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

WG Pasta

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

WG Pasta

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, eth:

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Pasta

 

 

Other hardship (please list):

Whole grain pasta has been nearly impossible to prepare in bulk and
hold without sticking together and turning into mush.

We are starting a pasta bar at the HS for the 2018-19 school year.
Pasta on the line without sauce that is brown is very unappealing to
students.

 

 

alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

. My srgnature Indicates that I understand and attest to the accuracy at the Intormatlon provuded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

374198er (\wou Webb/lg

Signature of Diricsor?df School Nutrition Program Date

our 7-- 

Program Coordinagf Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
GoVernor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort, Kentucky 40601
Phone: (502) 564-5625 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19 

Shelina McClain, as the duly authorized representatiVe of Graves County Schools, do hereby attest that the
aforementioned EPA and all schools under its jurisdiction demonstrate a hardship in proctiring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors Indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with art appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipis).
The temporary etemptions are allowed for any type of grain productis), pasta, bread, brotvn rice. etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products.
and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State?Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Ken 3373

KentuckyUnb?dledSpiril.com mama?s, ?wry An Equal. Opportunity Employer 



List the type of grain productls) to
be exempted and attach
Justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records. demonstrate a signi?cant drop in
meal counts after the whole.- grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the-whole grain-rich 

 

Limited product availability: The EPA does not have access. to a
compliant whole grain-rich in the local market and would
like to offerenriched grain itemls] temporarily.

Giorgio discontinued to manufacturer the whole
grain pizza the students at Graves County
preferred. The results from a taste testing
identi?ed the replacement for Giorgioto he the
non-whole grain Alpha pizza.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productisl offered by the SPA did not retain the desired
texture or lost palatabil'rty during the typical holding time.

 

 

 

 

Hardshipis]:

List the type of grain product(s) to
tie-exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

 

the SPA received signi?cant negative student/pa rent feedback or there
was increased plate waste of that menu item when the whole grain-
rich' productis) was offered multiple times and over a sustained period
of time.

Poorstudent acceptability: The whole grain-rich productis) offered by-

Giorgio discontinued to manufacturer the whole
grain pizza the students in Graves County
preferred. After'tasie testing with-students the
non-whole grain Alpha pizza was selected by the
student body. 

 

Other hardship (please list):

 

 

l'

 

 

Listalternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Crust Cheese 8: Pepperoni Pizza Alpha Foods

SP162R aspirate

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy ot the information proiriclecl above. that all

records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Macaw were; WSW

 

 

 

 

Signature of Director of School Nutrition Program Date
6?5 7?
SCNIMC Program CS?rdinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.kygov

mack?g

anemone ?my An Equal Opportunity Employer MIFID

 

Steven L. Beshear Terry Holtiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower a 500 Mero Street 0 Frankfort, Kentucky 4060'!
Phone: {502) 5644??!) 4? 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014~2015 and 2015-2016

i, Shetina McClain, as the duly authorized representative of Graves County School District, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain~
rich products that are acceptable to students, and that the factors indicated in this document pose a chaiienge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
Nationat School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the reguiatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014?2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptabie to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whoie
grain?rich products.

The State Agency wili consider hardship factors in allowing an exemption for the iisted whole grain-rich product(s) for
the remainder of SY 2014?2015 and 2015-2016. Place an in the appropriate cotumn or columns (Yes) for each
hardship consideration. if your hardship is not iisted, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpirit.com An Equai Opportunity Employer 

   

UNBRIDLED SPIRIT

 

List the type of grain productis)
to be exempted and attach

 

 

 

 

 

 

 

 

 

Yes Hardship(s): justification (pictures, receipts,
etc. for documentation):
Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich product(s) was
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productis).
Limited product availability: The SFA does not have access to a Regular Sized Cinnamon Roi!
compliant whoie grain-rich productis) in the local market and
wouid like to offer enriched grain item(s) temporarily,
Unacceptable product quality: The whole grain?rich product(s)'
offered by the SFA did not retain the desired texture or lost
during the typical holding time.
List the type of grain product(s)
Yes Hardship to be exempted (attach
production record):
Poor student acceptability: The whoie grain-rich product(s) WhoieGrain Rice

offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whoie grain-rich product(s) was offered multipie times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/ brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
Cinnamon Roll Biscuit Ralcorp 10153- Attached
Whole Grain Rice Rice Producers 134110~ Attached

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at least half of the grain items offered weekiy is whole grain?rich.

Wm a WW5
ignature of Director of Schools Date
(lizard) Wet? 4?47 oil;

Approved Program Manager Date



. *Piease complete this form, sign, a ectronically submit to Sue Bartenfield at 

is an equal opportuntty provider and employer.?

Page 3 of 3

 

 

Steyen L. Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street . Frankfort, Kentucky 40601
Phone: (502) 564-4770 0 wmmeducationkygov

Request for Exemption for Whole Grain-Rich Requirements
School?Years 2014-2015 and 2015-2016-

I, Shelina McClain, as the duly authorized representative of Graves County School District, do hereby attest that the
aforementioned, SPA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (8Y5) 2014-2015 and 2015?2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for
the remainder of SY 2014?2015 and SY 2015?2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpiriicom An Equal Opportunity Employer 

 
    

UNBRIDLED 515:an .-

 

 

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation}:

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich producds) was
offered.

Whole Grain Biscuit

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grainnrich product(s} in the local market and
would like to offer enriched grain item(s) temporarily.

WG Crackers Zesta Mini

 

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SFA did not retain the desired texture or lost
during the typical holding time.

 

Whole Grain Biscuit

W6 Crackers Zesta Mini

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s}
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

Whole Grain Biscuit

 

 

 

Other hardship (please list):

 

 

List alternative product types/ brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
Biscuit Biscuit Ralcorp 10077- Attached
Crackers Sunshine Harvest Wheat General Mills 114378- Attached

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that ali records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half ofthe grain items offered weekly is whole grain~rich.

Wm mm, so [15'

Signature of Director of Schools Date

WW ?75-20 45>?



Appr ved Progra Mama er Date ,1
4/34 lib
*Ple mplete this form, 51' and etectronically submit to Sue Bartenfield at su . artenfield@education.ky.gou

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary ?exibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-

17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich product(s) for the

2016-17 school year. This extension will be in effect for the 2016-17 school year and the SFA is responsible for ensuring

availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other tried in the proper columns below.

 

 

 

 

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain

an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. Poor Student Acceptability, Other) Tried and Were not Accepted
Fiesta Rice- Diamond Poor Student Acceptability Rice Brown Whole
#134048 Grain/Producers #134110
White Rice? Uncle Poor Student Acceptability Rice Brown Whole

Ben's #134108 Grain/Producers #134110
Biscuit? Peach Valley Poor Student Acceptability Whole Grain Biscuit/Mary
#10532 B's #10151

Crackers? Sunshine Poor Student Acceptability No WG product on bid
Harvest Wheat #1 14378

Tornado- Ruiz Limited Product Availability No WG product on bid
#19620/#1961 0

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

J??k?q

 

Director of Schools Date
Date

 

1"Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer."

Page 1 of1

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Grayson County Board of Education

Name of Product a waiver is being requested for:

0 Pasta, 10? Spaghetti for Spaghetti Recipe Chili Recipe (A Zerega Brand)

Brand Name of product used:

A Zerega

Recipe(s) in which the product is used:

Spaghetti, 8: recipes

Other products tested:
- Barilla Whole Grain Spaghetti
Barilla Whole Grain Elbow Macaroni

We also sampled some Ultragrain products.

Issues with products used and tested:

Students complained of the appearance (brown). We thought if we "covered it up? with spaghetti
sauce or put the pasta in chili, it would be less noticeable, but students complained. Students have
accepted whole grain rich bread and whole grain breaded chicken strips pretty well; however, these

whole grain products have a grittier texture. We need more time to sample products and conduct
student taste testings to find student-accepted products for our kitchens.

internal Use Only

 

Date Submitted: 319.411

Date Approved: 1?
Approving Signature: MW 

R11. ego/t? vow/1n Mat 

 Prior Waiver Request for Whole Grain Rich Pasta 2014-2015

Instructions: Submit a completed waiver request form?for each individual pasta product for which a I
waiver is desired for SY 2014 2015.

Sponsor Name: Gravson County Board of Education

Name of Product a waiver is being requested for:

Pasta, Spirals, used in Macaroni 8: Cheese Recipe for middle 8: high schools (A Zerega Brand)

Brand Name of product used:

A Zerega Brands (noted above)

Recipe(s) in which the product is used:

Macaroni Cheese

Other products tested:
0 Barilla Whole Grain Rotini
Barilla Whole Grain Elbow Macaroni

a We also sampled some Ultragrain products.

Issues with products used and tested:

Students complained of the appearance (brown). We thought if we "covered it up? with cheese for
macaroni 8: cheese it would be less noticeable, but students complained. Students have accepted
whole grain rich bread and whole grain breaded chicken strips pretty well; however, these whole

grain products have a grittier texture. We need more time to sample products and conduct student
taste testings to find student-accepted products for our kitchens.

Internal Use Only

 

Date Submitted: 

Date Approved: \v 
Approving Signature: WW
{?362er ski-mg espouse grab/Look
BSWNOL 9w won/HT?

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Grayson County Board of Education

Name of Product avwaiver is being requested for:

0 Pasta, Elbow Macaroni, used in Macaroni Cheese Recipe for elementary schools (Patria
brand) 

Brand Name of product used:

Patria

Recipe(s) in which the product is used:

Macaroni 8: Cheese

Other products tested:
0 Barilla Whole Grain Rotini
Barilla Whole Grain Elbow Macaroni

I We also sampled some Ultragrain products.

Issues with products used and tested:

Students complained of the appearance (brown). We thought if we "covered it up? with cheese for 
macaroni 8% cheese or put the pasta in it would be less noticeable, but students complained.
Students have accepted whole grain rich bread and whole grain breaded chicken strips pretty well;
however, these whole grain products have a grittier texture. We need more time to sample products
and conduct student taste testings to find student-accepted products for our kitchens.

internal Use Only

 

Date Submitted: XV 304?!

Date Approved: I V3 PI 
Approving Signature: 

I Rm mot/Kat} cC-Gv?t (191% 01/155,01an
@nmf?x. Hng'tna?r mari'hw.

?Ma/Ls 092le

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

3 
Cliff-p. 8MB the duly authorized representative of Name], do hereby attest

that the aforementioned SFA and all schools under its iurisdict'on demonstrate a hardship in procuring, preparing, or
serving compliant whole g'ain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides fiexibilities re'ated to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

 

may approve an exemption request for specific products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

27%

KentuckyUnbridledSpirit.com swan-y An Equal Opportunity Employer 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support are available upon request by the State Agency.

77

Date

  
 
   

Signature of Director of School Nutrition Program

[a f. 377/7

l5rogram Gab?rdinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

t?
KentuckyUnbridledSpirit.com An Equa Opportunity Employer MIFID

 

 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

STUDENTS DO NOT LIKE THE WG
BISCUITS AS SEEN IN PHOTOS ALSO

-WG PASTA IS NOT ACCEPTED WELL.

 



List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received significant negative student/parent feedback or there

WG BISCUITS AND PASTA.
WOULD LIKE TO HAVE

 

 

 

 

 

 

 

 

was increased plate waste of that menu item when the whole grain- WAIVER FOR MEXICAN
rich product(s) was offered multiple times and over a sustained period RICE.
of time.
Other hardship (please list): STUDENTS COM 
ABOUT THE WG PASTA
AND BISCUITS
List alternative product types] brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
I SC IT SOUTHERN STYLE BISCUIT DOUGH 133493
SPAGHETTI SPAGH ETTI KITCHEN ESSENTIALS GFS 654560
MEXICAN RICE MEXICAN FIESTA RICE UNCLE 473006

 

 

 

 

 

 

 

 

Matthew Bevin
Governor

Stephen Pruitt, 
Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET

DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mare Street - Frankfort. Kentucky 40601
Phone: (502) 564-4??0 - 

Request for Exemption for Low-Fat Flavored Milk

For School Year 2017-18



I, 60 ?Mt as the duly authorized representative of Hmm? Ca Stl?SFi?. Name], do hereby attest

that the aforementioned SEA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(c) of the Appropriations Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk
fat) flavored milk through the NSLP and the SBP 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.

Yes Hardshipis):

Documentation Submitted
(invoices, waste study,
production records, etc.)

 

Significant decrease in milk sales since implementation of the
current meal pattern.

 

Declining milk sales despite offering alternative products and
brands.

 

A food waste study indicating significant waste of fluid milk.

Piaf-"c! 
(DO 4" Cerf-0M .5le

aim-Ml- 

 

Significant negative feedback from students and parents
regarding lack of availability of low-fat, flavored milk

 

Signi?cant negative feedback from students regarding the
palatability of fat-free, flavored milk.

 

 

 

 

 

KentuckyUnbridledSpiril.corn

K01 .mde

An Equal Opportunity Employer MIFID

My signature indicates that Understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency.

M04 go?b cl?l?-l7

Signatur7irector of School Program Date
ApprodEJ'Program Manager 

 

Date
*Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.Wagner@education.ky.gov

is an equal opportunity provider and employer."

Page 2 of2

Hal Hefner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Edueation

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, lit 58 [rh? as the duly authorized representative of Hugg? ?n . Name], do hereby attest
that the aforementiorl?ed SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

:3
KentuckyUnbridledSpIrit.com An Equal Opportunity Employer MIFID

WPIRIT

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The EPA does not have access to a

compliant whole grain-rich product(s) in the local market and would I

like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(sl to
be exempted (attach oduction
record): 3" 

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

BIS:


Grad/bis ?Judi:

3 rwalS AWL

 

 

Other hardship (please list]:

 

 

List alternative product types/ brands that have been utilized: )3 fame. a; WA 

 

Grain Item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above that all
records to support the information are available upon request by the State Agency.

 

 

 

7
Signature of Director oi Program Date
.SCNIMC Program Coordinator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@eduoation.ky.gov

Karmic?



An Equal Opportunity Employer 

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, JACK MINIARD, as the duly authorized representative of HARLAN COUNTY SCHOOL FOOD SERVICE, do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215. 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s], pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, eth: WHOLE GRAIN
CRACKERS

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

VENDOR INFORMED US THE WG
CRACKERS ARE NO LONGER AVAILABLE

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

STUDENTS GIVE NEGATIVE FEEDBACK
ABOUT THE TASTE, TEXTURE AND
APPEARANCE OF THE WG CRACKER.
CRACKERS ARE BEING WASTED AS
STUDENTS THROW THEM AWAY IF
THEY TAKE THEM.

 

Other hardship (please list):

 

List

 

 

 

 

alte
mative product types/brands that have been utilized:

 

Manufacturer Product Code

ere

Grain item
we CRACKER

Product Description
WG CRACKER

 

 

 

 

 

 

 

My signature indlcates that I understand and attest to the accuracy or the Intormation provrded above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

7772/ Mill

Sign?Ire of Dlrector of School Nutrition Program Date

a a 9? 4371/

44..
ogra7n?1 Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

 

 

 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014?2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name:

Harlan County Public Schoois

Name of Product a waiver is being requested for:

Elbow macaroni made with durum wheat

Brand Name of product used:

Barilla

Recipe(s) in which the product is used:

Macaroni 8: Cheese

Other products tested:

Spaghetti, Rotini-plain, Rotini-Tri Color

Issues with products used and tested:

Macaroni Cheese doesn?t hold well; texture is chewy when cooked the correct amount of time. if
cooked longer it becomes too soft and not appetizing. Color is not pleasant, flavor is stronger. Students
think it is left over due to the color.

Internal Use Only

 

DateSubmitted: 7r?rc5lal21
DateApproved: 7??*010l11

Approving Signature: 2 ..
2964a: (Mari/wk

:83 01/22 cold/4x annals may 4- bah/K? aS-v (4)6 rm. I: 
Wham mmOn.

 

Steven L. Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE CABINET
DEPARTMENT OF EDUCATION

Capital Piaza Tower 9 500 Moro Street a Frankfort, Kentucky 40601
Phone: (502} 5644770 a vmw.oducation.ky.gov

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015-2016

l, Jack Miniard, as the duly authorized representative of Harlan Co Board of Education SFS, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whoie grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235}, Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whoie grain-rich requirement in the meal programs, in schooi years (SYs) 2014-2015 and 20152016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whoie grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).

The temporary exemptions are allowed for any type of grain productls}, pasta, bread, brown rice, etc.) and for one 

or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabie
products, and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridiedSpintcorn An Equal Opportunity Employer 

   

HemrLo SPIRIT

Yes

Hardship(s):

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring thewhole grain?rich productls). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the iocai market and
would like to offer enriched grain itemls) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
during the typical hoiding time.

 

BISCUITS, COLOR 
ELBOW MACARONI,
ON CHICKEN
NUGGETS

 

 

Yes

Hardshipls):

List the type of grain productls)
to be exempted (attach

production record):

 

Poor student acceptability: The whole grain-rich productls)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich productls) was offered multiple times
and over a sustained period of time.

TRI COLOR 
ELBOW SPAGHEWI,
BREADING ON CHICKEN NUGGETS

 

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item

Product Description Manufacturer

Froduct Code

 

WG BISCUIT

FROZEN BISCUIT GUENTHER

331539

 

 

 

 

 

 

 

 

Page 2 of 3

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAS receiving the exemption
must ensure that at least half of the grain items offered weekly is whoie grain-rich. -

.- y? 
?ezaiw/

 

 

 

Signatpf?/of Director 0? Schools Date
4; 
WW ML 5
Approved Program ManagerU Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at sue.bartenfield@educationkygov

is an equal opportunity provider and employer.?

Page 3 of 3

 

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016-2017

i, 3305? Miniard as the duly authorized representative of Harlan 00 Bd 0f Ed SFS Name],
do hereby attest that the aforementioned SFA and all sChoois under its jurisdiction demonstrate a hardship in procuring
compliant whole grain?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public taw 113-235}, Congress directed the Secretary of Agriculture to allow State Agencies
that administer the Nationai School Lunch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole. grain~rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls}.
The temporary exemptions are allowed for any type of grain productls), leg, pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013~2014 requirement of at least half of the grains offered weekly are whole
grain?rich products.

The State Agency wilt consider hardship factors in allowing an exemption for the listed whole grain-rich productls} for SY
201541017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is

not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016?2017

Memorandum SP33-2015 extends the ability, previously authorized by Section 751 of Public Law 113?234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the Nationai School Lunch Program
(NSLP) and School Breakfast Program through the school year 2016-17. Ali temporary. fiexibilities approved by a State
Agency under this superseded memorandom may continue under the terms they were approved, through school year 2016?
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whoie grain-rich for the
201647 school year. This extension will be in effect for the 2016?17 school year and the SPA is reaponsible for ensuring
availability of whole grain rich products to meet the-100 percent ofgrains offered must be whole grain rich requirement
for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

 

 

 

 

 

Grain Product for Continued Hardship (Financial Other Whoie Grain Products/Brands That Have Been
which an Extension of Hardship, Limited Product Availability, Tried and Were not Accepted
Waiver is requested. Poor Student Acceptability, Other)
Biscuit Poor Student Acceptability Guenther
Elbow Macaroni Poor Student 
Spaghetti I Poor Student Acceptability Berilla
Breeding on I
Chicken Nuggets Poor Student Brekebush, Tyson

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half he grain items offered weekly are whole grain rich.

June 6th, 2016

nature of Dir/ctor of Schools Date

   
  

AMA 6ft A 

SEN/inf: Program Coordinf or Date
*Please complete this form, sign, and eiectronlcaliy submit to Sandy Wagner at sandra.waener@educationkmm.

is an equal opportunity provider and employer."

Page 1 0H

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

300 Sower Building - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018 20 i ?1




l, Emil? If ,as the duly authorized representative of Marla? Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain- -rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 747 of the Appropriations Act provides flexibilities related
to whole grains, sodium and ?avored milk for school year (SYI 2017-18.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the
remainder of SY 2015-2016 and SY 2016 2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extension from SY 2016- 17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals Whole Grain- Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017- 18.

*Reference: SP 32-2017
SP 33-2016

rude: ?a
?uxes ?my An Equai Opportunity Employer MIFFD

List the type of grain productls) to
be exempted and attach

Hardshipls): justification (pictures, receipts.
etc. for documentation):

.. I ?r?A/Kgrs

I I. I 4-. .. 
Financial hardship: The SFA's records demonstrate a significant drop in no IE 6 I 
meal counts after the whole grain-rich productlsi was offered. in 0 l8 0? i i3;g CW1:

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemis) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
Brain-rich productls) offered by the SPA did not retain the desired grand 

texture or lost palata bility during the typical holding time.

 

 

 

 

 

List the type of grain productls} to
Hardshipls): rezj?mpted (attach production

 

Poor student acceptability: The whole grain-rich productls) offered by

the SFA received signi?cant negative student/parent feedback or there 6? 01rd If i? 5
was increased plate waste of that menu item when the whole grain- B: 6 Ctu 5
rich productls) was offered multiple times and over a sustained period - a9
oftime. sPaneH" 4
Other hardship (please list):

 

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

Yet

my Signature Indicates that I understand and attest to the accuracy or the Intormatton pfOVlded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

QMLK '7 1%

Signature of Dir?t? of School Nutrition Program Date

 

 

AM 

Coordinat Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentuckyUnbridledSpirit. com

[(01er ?15

anemone sewn-y An Equal Opportunily Employer MIFID

Hal Heiner

 

Matthew G. Bevin Secretary
Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt. 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower 0 500 More Street Frankfort, Kentucky 40801
Phone: (502) 564-3141 - 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
Ch ri Ru 339" Hart County Schools
I, . as the duly authorized representative of Name], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

- Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017.

SP 33-2016

cmudzg 
KentuckyUnbridledSpirilcom unanmuso SPIRIT An Equal Opportunity Employer MIFID

Yes



List the type of grain productisi
to be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant
drop in meal counts after the whole grain-rich productts) was
offered.

MIG 3156c" PS 4 Cr?tkerS

 

Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich productisl. 

 

Limited product availabilim The SFA does not have access to a
compliant whole grain-rich productis) in the local market and
would like to offer enriched grain itemls) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SPA did not retain the desired texture or lost

during the typical holding time.

we cl: Crackers

 

 

Yes

Hardshipis):

List the type of grain productis)
to be exempted {attach
production record):

 

Poor student acceptability: The whole grain-rich productts)
offered by the SFA received significant negative studentiparent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multiple times
and overa sustained period of time.

W13 Breeutls Crackers:

 

if

 

 

have not atop-lea! ?l-i1e_t-id- l3tsc..'.is
m?ai COLLatib 0.1 ?at. days tun-Is art. 0

LI it: talks). On 4- Srf??lj dds] 44?. pork
(cl: ?Hmt. i151 i: Sdaool. Prawn HI

or- -H~e G. creel?. ers.
C(ureJ have den-usual,
Cl?tk- bur:- "ldS 8 

. I-IS served 11135 +0 approx,
min} Hie-n. Ova-all

 

\?50 S?l?u i3 gimbals 5.

bkaE-et pectic-\mi-tm at HS has. clearelszsec? (must: in 351?

 

I

list alternative product types! brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
Eii?iaui- l?Jiacd-?i Cen.M.lls V3722. 
Of?ckcl'S . Salt-me, Calcite Weshtinsi?i? 3001 '7

 

 

 

 

 

 

Page 2 of 3

 

 

 

List the type of grain productls) to
be exempted and attach

Hardshipls): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain productfs) to
Hardship[s): (attach production

 

Poor student acceptability: The whole grain-rich productls) offered by WG Crackers
the SPA received significant negative student/parent feedback or there WG Biscuits
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

15W 3/20/5-
Gama .

 

 

 

 

List alternative product types] bra that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

my signature indicates that I understand and attest to the accuracy at the intormation provided above. that all
records to support the information are available upon request by the State Agency.

8/2/2017

 

 

 

Signature of Director of School Nutrition Program Date
M42
36 Program Co?r?dinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandramagner@education.ky.gov

KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

 

Steven L. Beshear I Terry Holliday, 
Governor Commissioner of Educatjon

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Piaza Tower 500 More Street 6 Frankfort, Kentucky 40601
Phone: (502.) 564-4770 s: mmeducatiomkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014?2015 and 2015?2016

t, Chr?ig (Qt-tagger. as the duty authorized representative of Hart Co (Schooislsm Name), do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole -
grain~rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole-grain-rich products. in Section 751 of the Consotidated and Further Continuing Appropriations Act, 2015
(Public taw 113435), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National Schoot Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meat programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students. -

 

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are aitowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptahte
products, and must comply with the SY 2013~2014 requirement of at least half of the grains offered weekty are whote
grain?rich products. 

The State Agency wtti consider hardship factors in aliowing an exemption for the listed whole grain-rich productis) for
the remainder of 2014-2015 and SY 20152016. Ptace an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted. 

KentuckyUnbridtedSpiritcom An Equal Opportunity Employer 

 

YES

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal ceunts after the whole grain?rich producds) was
offered.

WC: emanate; Cic?lcicerg .

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich product(s].

 

Limited product availability: The SFA does not have access to a-
compiiant whoie grain~rich producds) in the lace! market and
would iike to offer enriched grain item(s} temporarily.

 

 

 

Unacceptable product quality: The whole grain?rich producds)
offered by the SPA did not retain the desired texture or lost

- paletability during the typical hoiding time.

ti? Crackers

 

 

Yes

Hardshipls):

List the type of grain produc?s)
to be exempted (attach
production record):

 

Poor student acceptability: The 'whole grain-rich producds)
offered by the SPA received significant negative student/parent
feedback or there was increased piate waste of that menu item
when the whole grainwrich producds) was offered multiple times
and over a sustained period of time. 

MIG {Biscuits ?t 

 



 

 

Li (Na (Umpire-d kit-w. stir? 

[?an is On ?i'inel days i-?i-?n?ts Cxi'tf. 
eignifumm the. infzi 663?1001? euro?; 7? .E
(60 Shtdani'g?, bw?i?Ccti?i??-t\ ilk?Y 9? {j }3 344416? if) 

Di" La.) Ct; ?i?i?kgps,
(La-:23 have dec?easec?,

has dc? c0251; .9 Ci

. H3 Served fining +0 %p{axl
it?d"; "f?Iir?TS? i?m'ht Ou?raii

 

 

ba?akCaet Pet?i?i?ci?ee?i?kvx at ?er. HS has decor:

used. ?ow-t LiS?i-a it) 135%

 

r?

List alternative product types/brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
{5 ic-sctti'i (2?2 39cm Wrote, Cracked? Wegtmiosi?f 723001 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that alt records
to support the information are availabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whoie grain?rich.

 

 

- 

f}
{Lavage/KL?? 5 ~13 45
Signature of Director of Schools Date 

WC 3 2 #5
Approved Program Manager Date

*Ptease complete this form, Sign, ?and electronically submit to Sue Bartenfield at 

is an equa! opportunity provider and empLoyer.?

Note 5% .
acceatatzl; 010 an mam 9m Jams; has
90ij memoge?dw as ?Hth age ?atten? 1+8 "Lew"?
QL LOG S?a?HweC makers are
gimpLj hot ii):t:ttebla,

to 6: Ream; at we Sam?

Page 3 of-3

 
Request for an Extension of Whole Grain Waiver Exemption ?0

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school yeer2016~17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under
the terms they were. approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich

product(s) for the 2016 17 school year Thismextenslon bet effect for the 2016-7school 
the SPA is "res; onsible ofr ensu rm evallabilit - rain re__duots to meetthe'i 9Q 
grains offered must be whole drain rich requirement for the 2017-18 school year.

   
       

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other tried in the proper. columns below.

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain
which an Extension of Hardship, Limited Product Products/Brands That Have
Waiver is requested. Availability. Poor Student Been Tried and Were not
Acceptability. Other) Accepted
WG Crackers Poor Student Acceptance WG Crackers -Kellogg?s
Whole Wheat Crackers-

Westmingter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure that at least hall of the grain items offered weekly are whole grain rich.

?ock Km W910 ?igng/G

Signathre of Director of Schools

?54.7% my 777 

Program Coordinator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Rachel Miller, as the duly authorized representative of Hazard Independent Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain?rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for Speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), ie.g., pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) 1i?or the
2013-19 school years. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain prod uctis) to be exempted.



List the type of grain product(s) to
be exempted and attach
justi?cation documentation
{production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

limited product availability: The SPA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

Dumplings and Hush Puppies

 

 

Preparation Hardship:?Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
texture or lost palatabllity during the typical holding time.

 

 

Hardshipls):

List the type at grain productis) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, etc):

 

Poor student acceptability: The whole grain-rich productts) offered by
the SPA received signi?cant negative studentfparent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

We've only purchases the pancake mix
during play off season. The students
have asked for regular pancakes this
year. Attached are production records
for last yea r.

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Pancake Mix Pancake Multl Grain Gordon Foods

143271

 

 

 

 

 

 

 

 

 

my Signature Inolcales mat unoerstanu anu attest ll.) the accuracy on me nuumlauon pwwoeo aoove. mat an
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the graln Items offered weekly are whole grain rich.

5:9 mm ?vi?62M?
Signa ure of Director 0 School Nutrition Program Date

7133/

gram CoorWor Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@eduoation.ky.gov

 

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education 

KENTUCKY DEPARTMENT OF 

Capital Plaza Tower . 500 Mero Street 0 Frankfort, Kentucky 40601
Phone: (602) 564-3141 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Rachel Milier, Food Service Director - ti ., Schools 
I, . as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain?rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to

whole grains, sodium and flavored milk for school year (SY) 2017?18.

may approve an exemption request for specific products if the SEA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption mUSt comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition. KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

i 
KentuckyUnbridledSpiriLcom An Equal Opportunity Employer 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The EPA does not have access to a
compliant whole grain-rich productts) in the local market and would
like to offer enrich ed grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardshipis):

List the type of grain productis) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SFA received signi?cant negative student/parent feedback or ther-
was increased plate waste of that menu item when the whole grai -

     
   

 

- Chicken Tenderv
1 we Chicken Slick: 

c.
far-H9}

 
 

 

 

 

 

 

rich productts) was offered multiple times and over a sustained p- riod

of time.

Other hardship (please list): 2015-2017 STUDENT
SURVEYS REQUESTED
CHANGING FROM SOME WG
BREADS TO REGULAR
BREADS. SEE ATTACHED
SURVEYS

List alternative product types/brands that have been utilized:
Grain item Product Description Manufacturer Product Code

 

See attached sheet 0F LISTED ITEMS

 

 

 

 

 

 

 

 

 

 

Ust alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
W6 Chick-2 ? Tenders WG Chicken Tenders, cooked, Kings Delight I 10072745662031
frozen
/W5?thicken Sticks WG Chicken Sticks, Breaded, Tyson 31400072953
cooked, frozen 0.43 oz.
WG Chicken Rings WG Chicken Rings, Breaded, Tyson 070366-0928
cooked, frozen .74 oz.

 

 

 

Grain Item Product Description Manufacturer Product Code

 

1V5 Chicken Hussets WG Chicken Nuggets, breast Kings Delight 10072745662048
meat, WG, cooked, frozen 0.06

A, 02.

 

 

Wild-lini- 

 

 

 

 

 

 

 

 

we Biscuit Dough W6 Biscuit Dough 2.51 oz. Pillsbury 94562-32268
Grain Item Product Description Manufacturer Product Code
WE Crackers HAD AN EXPEMTION IN 16-17
SY

 

 

 

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above that all
records to support the information are available upon request by the State Agency.

Signature of Director of School Nutrition Program Date 

7-7.2 

Date

 

   

 

 

I Frogram Coord

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

?Wm? um

KentuckyUnbridledSpiritcom Km um,;;y An Equal Opportunity Employer MIFID

 

 

Steven L. Beehear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower 3 5110 More Street a Frankfort, Kentucky 40601
Phone: (502) 564-4710 wweducationkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

l, Rachel Miller as the duly authorized representative of Hazard Independent Schools do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section ?51 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain?rich requirement in the meal programs, in school years (SYsl 20144015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls}.
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns {Yes} for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be
exempted.

Kentuckytinhridledspirilcom ??ax An Equal Opportunity Employer 

 
   

UNERIQLED EPIRJT . -

 

 

Page 2 of 3

 

 

 

 

 

 



1

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,

 

 

Yes Hardship(s):
etc. for documentation):
Financial hard-ship: The records demonstrate a significant) 
drop in meal counts after the whole grain~rich productls) was
. offered. - 
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich productis]. it}
Limited product The SFA does not have access 
compliant whoie grainerich productls) in the local market and
would like to offer enriched grain itemlsiternporariiy.
Unacceptable product quaiity: The whole grain=rich productis) it
offered by the SFA did not retain the desired texture or iost
during the typical hoiding time.
List the type of grain productls?)
Yes Hardshipls): to be exempted (attach
. production record):
iPoor student acceptability: The whoie grainrrich "productisl 1
i offered by the SPA received significant negative student/parent 
?2 feedback or there was increased plate waste of that menu item
when the whole grainerich productis) was offered multiple times
and over a sustainedperiod of time.
Other hardship (please list):
i
i
i
i

List alternative product types/brands that have been utilized:
Grain item Product Description Manufacturer 1 Product Code i
- 
Chix Chuncks WG Breaded Chix Chunks Tyson 23700100832
i
i i i
3 Chix Nugget we Breaded Chix Nugget Tyson i. 23700033765 1
Chix Tender W6 Chix Tender Tyson 1 23700033857 

List alternative product types/brands that have been utilized:

Grain Item

WG Biscuit
?WK&?E??eau

. w?mCrackers

 

Grain Item

. .
Wheat Crackers

WG Lasagna

WG Penne

 

Grain Item
WG Rotini

we Spaghetti

WG Macaroni

I.

Grain item
'uve
. Chicken Pattie

WG
Chicken Rings

 

.1

Product Description
.. WG E2 Split Dough Biscuit
WG Dough Biscuit

WG Crackers


1.

Product Description
Whole Wheat Crackers


i

Pasta Lasagna WHL Wheat?
iiJkra 
Pasta Penne Rigate 51% WG

Pasta Eibow Macaroni 51% W6

Product Description
Ap Chicken Patty, we, rc

WG Chicken Rings Brd.

 

Manufacturer

General Miils

. Rich Products

Kelloggs

Manufacturer

Westmingter

catasaawm

Dakota Growers

 

7

Product Description i Manufacturer

Pasta Potini 51% we Dakota Growers

Pasta soagheta 51% we Dakota ?rowers


Dakota Growers

Manufacturer

Tyson

Tyson

i

 

Product Code
10094562322634

49300093157

30100100881

. H..- 

Product Code
.?9321571b?31
?4giaicdb??im

"'1o7s7ss7szoibs

 

Product Code
1076733?920211

i 10767337913220

10767337921095

 

Product Code
*23700033395

*23700033970
i
I.

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that alt 
to support the information are avaitable upen request by the State Agency, and that the SFAs receiving the exemption
must ensure that at ieast haif of the grain items offered weekiy is whole grain-rich.

am is . 54 :5

Sighahre of Director of Schoolg Date

A. ml??'?Ln UNTA 4 1 {56.14 may

AM Pr ram nager 3 03m 
iease cemhplete this_forn1 Sign, ?(Actronkally submit to Sue Bartenfield at sue. gartenfield??education.ky.gov

is an equai opportunity provider and empioyer.?

  
 

Page 3 of 3

Hal Helner

Secretary

Education and

Worldorce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 500 than: Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, Sidney Rothenburger, as the duly authorized representative of Henry County Public Schools do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipls].
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
remainder of 2015-2016 and 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain?Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpiritcom Kama-Ir ?Zy An Equal Opportunity Employer MIFID

Hardshipis):

List the type of grain productis) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain?rich productls).

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productls] in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost during the typical holding time.

 

 

 

Hardshipis):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Rice The students are not accepting of
the whole grain rice and GFS (prime
vendor) does not offer a whole grain
fried rice. I think the students would
be more accepting of fried rice with
our Asian meal.

 

Other hardship {please list):

 

 

list alternative product types] brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

 

My signature Indicates that i understand and attest to the accuracy or the Intorrnatlon pl'OVldeCl above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain h'ch.

Lea/aw, 2.3m?

Signature of Director of Scl?ol Nutrition Program Date

SCN Program Coordihator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagher@education.ky.gov



An Equal Opportunity Employer MIFID

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mare Street - Frankfort, Kentucky 40601
Phone: (502) 664-3141 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, Sidney Rothenburger, as the duly authorized representative of Henry County Public Schools], do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-13.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
remainder of 2015-2016 and 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s] to be exempted.

Automatic extension from 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

"Reference: 5P 32-2017
SP 33-2016

KentuckyUnbridledSpi?tcom may An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardshipls): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SPA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). 

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain productis) to
Hardshipis): (attach production

 

Poor student acceptability: The whole grain-rich product(s) offered by Biscult
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productts) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer Product Code
Biscuit 2.2 oz Southern Style Easy Split Pillsbury 31524

 

 

 

 

 

 

 

 

 

My signature Inotcates that I understand and attest to the accuracy or the tntormatton provroeo above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain Items offered weekly are whole grain rich.

239% Qm?/ 2017

 

 

 

Sl'gnature of School Mien Program Dat 
Program Coordina? Date

Please complete this form. sign. and electronically submlt to Sandy Wagner at Sandra.wagner@education.ky.gov

Wi_ An Equal Opportunity Employer 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Sidney Rothenburger, as the duly authorized representative of Henry County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-20.110021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), le.g., pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,

and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
{production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop In
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain lternls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability durirg the typical holding time.

 

 

Ha rdshipls):

List the type of grain product(s) to
be exempted and attach
Justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Rice The students are not accepting 
the whole grain rice and prefer the
white rice. They did not choose the
Orange Chicken choice due to the
dislike of the whole grain rice.

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

Grain Item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

my signature that I understand and attest to the accuracy or the Intorrnatton prOVIded above. that all
records to support the lnforrnallon are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Mia: QUE 7.523.3/

Signature of Director of Schgal Nutrition Program Date

 

n/J/f?s 

SCN Progra'mVCooraig?toT Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mare Street Frankfort. Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

 

as the duly authorized representative MW Name], do hereby attest
that th aforementioned SFA and all schools under its jurisdiction demon rate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SYJ 201748.

may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014} requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 91? 2017-13.

?Reference: SP 32-2017
SP 33-2016

Kenmark?g

KentuckyUnbridledSpirit.com uuemoceo An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,

Hardshipls):
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant drop in W,
meal counts after the whole grain-rich product(s) was offered. ?00de 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain?rich product(s).

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemisi temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

 

 

List the type of grain product(s) to
be exempted [attach production

Hardshipls): recordi'

 

Poor student acceptability: The whole grain-rich product(s) offered by ?m??illw am, 31304 l-
the SFA received signi?cant negative student/parent feedback or there OCLULJ . m?w{wm
was increased plate waste of that menu item when the whole grain- NO If)
rich product(s) was offered multiple times and over a sustained period BTW 
of time.

Other hardship (please list):

 

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
lotg'i (6M0 6? mime/s- mm
mind pa_r}_caL( mum; m?akmm- 10 
imam (basmtw miffed MW 1 00??j

   
 
    

My signatu indicates that I understand and attest to the accuracy of the information provided above. that all
records to upport the info atlon are available upon request by the State Agency.

?ay/?7

School Nutrition Program Date'

(42: 

SC rogram Coordi??tor Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

tuck: 
An Equal Opportunity Employer MIFID

UNBRIDLED SPIRIT

 

Steven L. Beshear Terry Holliday, 
Governor . Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 More Street Frankfort, Kentucky 40801
Phone: (502} 564-4770 mmeducationitypov 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

HQ C0 
i, gthi? as the duly authorized representative of ?gu?q is Name], do hereby attest 

that the aforementioned SFA and schools under demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the?meal programs, in schooi years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), ie.g., pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in ailowing an exemption for the listed whole grain-rich productis) for
the remainder of 2014-2015 and SY 20154016. Place an in the appropriate coiumn or columns (Yes) for each
hardship consideration. if your hardship is not listed, inciude in the other hardship section. List the grain productis) to be
exempted.

KepluckyUnbridledSpirii.com_ An Squat Opportunity Employer MIFID

 

Yes

Hardshipis}:

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich producds) was
offered.

Whole 051-11th
biscuit.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productis). 

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich productis) in the iocai market and
would like to offer enriched grain itemis) temporarily. 

weleen
Cir-ac kers

 

 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SFA did not retain the desired texture or lost
palata during the typical holding time.

 

we totem-H?
we?zestq cr?tc hers

 

Yes

Hardshipis):

we": ?hr'iitiifv?s

List the type of grain productis)
to be exempted {attach
production record):

 

Poor student acceptability: The whole grainurich produciis)

webiscui?l

 

 

 

 

 

 

 

 

 

 

 

 

 

 

offered by the SPA received significant negative student/parent W6 1531';ng
feedback or there was increased plate waste of that menu item 
when the whole grain-rich productis) was offered muitiple times ?amp? 1?
and over a sustained period of time.
Other hardship (piease list):
List alternative product typesr?brands that have been utilized:
Grain item Product Description Manufacturer Product Code
. we)? Geneva-i1 cm;
win at Mills mew-rte mlLB?m
I. I 1
than l?i? eased l?l" Raging? I at? [001?]
- Mexicans"?
in TOW HQ .. on?mqi CBS #13010?)

Page 2 of 3

 

 

 

My'signature indicates that I understand and attest to the accuracy of the Information provided above, that all records
to support the information are avaiiable upon request by the State Agency, and that the SFAs receiving the exemption

must ensure that at least half of the grain items offered weekly is whole grain-rich.



St?na?tuYe of Direct of Schools Date

opportunity provider and employer.?

     
 
 

Page 3 of 3

 

Steven L. Beshear Terry Holltday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF 

Capitat Ptaza Tower 509 More Street a Frankfort, Kentucky 40601
Phone: (502} 564-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

. A do

i, CA 1?15 . QC. . as the duly authorized representative of 2, Name}, do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain?rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain~rich products. in Section ?51 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years {59(5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whoie grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain~rich produc?s) for
the remainder of SY 2014-2015 and SY 2015?2016. Place an in the appropriate column or columns {Yes} for each
hardship consideration. If your hardship is notlisted, inciude in the other hardship section. List the grain productls) to. be
exempted.

KentuekyU'nbridledSpiritpom An Equal Opportunity Employer 

 

Yes

Hardshipls):

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

"Financial hardship: The records demonstrate a significant

 

 

drop in meal counts after the whole grain-rich producds) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase the whole grain?rich productis). ii]

 

Limited product availability: The SFA dudes not have access to a
ccmpiiant whole grainwich producds} in the iocal market and
would like to after enriched grain itemls) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SPA did not retain the desired texture or iost
during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain preduct(.s}
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain?rich productis}
offered by the SPA received significant negative student/parent
feedback or there was increased piate waste of that menu item
when the whoie grain-rich productls) was offered muitipie times
and over a sustained period of time. .

 

 

 

Other hardship (please list):

 

 

 

 

List alternative product types! brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Beams ?Pillabaw?: (D QHSM. #0122252.
magi-{A (Lecrx mmW-{m ?31 ?j 73H?rio - 0 

 

Page 201? 3

 

 

My signature indicates that I understand and attest to the ascuracy of the information provided above, that records
to supper: the information are availabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at toast haif of the grain items offered weekly is whoie grain-rich.

:5
Date

93. 

Date

 

 

is an squat opportunity provider and empioyer.?

9399-3 Of'3

   

 

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Moro Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

a rCi OX Hcpiilns County Schools

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serv-ng compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productis] for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. lfyour hardship not
listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrit'on, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-13.

*Reference: SP 32-2017
SP 33-2015



KentuckyUnbridIedSpiritcom UNBRIDLED seven-y An Equal Opportunity Employer 

 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productts).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

WG Biscuit

 

 

List the type of grain productls) to
be exempted (attach production

 

 

 

 

 

 

 

 

 

 

 

Hardshi 
p( record):
Poor student acceptability: The whole grain-rich productls) offered by WG Biscuit
the SPA received signi?cant negative student/parent feedback or there WG Cracker
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.
Other hardship (please list):
List alternative product types/brands that have been utilized:
I
Grain Item Product Description Manufacturer Product Code
Biscuit Easy Split WG Biscuit Ralcorp 21031

Zesta Cracker Zesta Mini Saltine Kellogass/Kimble:L 113804

 

 

 

 

 

J. 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the Slate Agency.

 

 

SigiEture 61? Motor of School Nutrition Program Date
A, 45$: A ?7 '7 
Pr?agram Coy?ator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

(uric ?g
KentuckyUanidledSpi?tcom gazing: smart-y An Equal Opportunity Employer IWFID

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite . Frankfort, Kentucky 40601
Phone: (502) 564-5625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, Melissa Dooley, as the duly authorized representative of Jackson County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the Option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productts) to be exempted.

(if 5
KentucklenbridledSpirit.com mm An Equal Opportunity Employer MIFID

UWIRIT

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uctis) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls} temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Biscuit

WG Pasta

 

 

Other hardship (please list): We would like to offer regular biscuits in hope to
raise participation at our high school. The students complain that the whole grain
biscuit is to dark and doesn?t taste good. Our high school enrollment was 583 and we
average serving 165 for breakfast. See attached production records.

We stopped serving pasta several years ago because the students weren?t accepting
the whole grain well. We would like to offer regular pasta to better serve our
students and add variety to the menu.

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

W6 Biscuit Biscuit Pillsbury

132268000

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Information prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

549-?)

Date

   
 

 

Director of School Nutrition Pro ram

(1.. 4?wa

Pro?ram CoWor Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov


KentuckyUnbridledSpirit.corn An Equal Opportunity Employer MIFID

0M
?39 Had,

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6' Cc.
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Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

Julia Bauscher as the duly authorized representative of Jefferson County Public Schools do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Hardship(s):

List the type of grain productts) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(sl was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productts).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Fried Rice- Students did not like the
whole grain fried rice during School
Nutrition Advisory Council (SNAC)
testing.

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Fried Rice Whole grain rice with peas and Chefs Conner
carrots mixed with Asian style

sauce.

Ofc2149

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy at the Intormatlon prowded above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

wa more

 

 

 

 

Signature of Director of School Nutrition Program Date
?144. (a 
Program Cooyf?tor Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Moro Street 0 Frankfort. Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Jefferson Pubiich'noIs
l, T9 rlna as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

 

may approve an exemption request for specific products if the SPA can demonstrate hardshipis). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains

offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:
All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:

Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32?2017
SP 33-2016

[(01er a 
?Hammer, smart-y An Equal Opportunity Employer 

KentudtyUnbrid.?edSpirit.com

List the type of grain productis) to
be exempted and attach
justi?cation (pictures. receipts,

Hardshipls):
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meai counts after the whole grainorich product(s] was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productts).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardship(s): record)?

 

Poor student acceptability: The whole grain-rich product(s) offered by 
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

Biscuit Whole Grain Easy split biscuit OH. GuentheriPioneer 3043

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency.

2-9/0 

 

 

 

Signature of Director of School rition Program Date
1? /32 n% 3 
SCNIMC Program Coo??ator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

MW

KentuckyUnbridledSpiritoom UNBRIDLED Hwy An Equal Opportunity Employer MIFID

Hal Heiner

Secretary

Education and

Workforce Deveiopment Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mare Street - Frankfort, Kentucky 40501
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I Terina Edington 

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half 'of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016?17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016


[(ts'muckyM
KentuckyUnbridledSpirit.com unenroczo 5mm?- An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
.grain- -rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

Elbow Pasta

 

List the type of grain product(s) to
be exempted (attach production

 

 

 

 

 

 

 

Hardship(s):
record):
Poor student acceptability: The whole grain-rich product(s) offered by Elbow 3 st 8
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.
Other hardship (please list):
List alternative product types/ brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
Pasta Elbow Barilla 1000-01 1 -150

 

 

 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above. that all
rec?ds to support the information are available upon request by the State Agency.

(m '7

Signature of Director of School Nlitrition Program Date


{4a 

Program Coordinate?F Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

rude? 

KentuckyUnbridledSpirit.com uwamomo An Equal Opportunity Employer MIFID

a? 

4?
p.

     

SW00:

0N



Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Susan Baker, as the duly authorized representative of Jenkins Independent ?ghgol District, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the apprOpriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The EPA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain item(s) temporarily.

Hushpupples

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s} offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardship(s):

List the type of grain productts) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
oftime.

 

Other hardship (please list):

 

 

 

List alternative product types} brands that have been utilized:

 

 

Grain Item Product Description Manufacturer Product Code
Grabitizers These hush puppies McCain 159760
Hushpuppies are made with fresh
cornmeal. chopped
onions. parsley,

sugar and spices for
true Southern ?avor

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Inton-natlon protruded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

7?30 

 

 

 

 

Signature of Director of School Nutrition Program Date
ALA ?e 9-1 we
Program Coordinagf Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

susan Baker Jenkins Independent School District


as the duly authorized representative of Name),
do hereby attest that the aforementioned SFA and ail schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a chailenge in offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National Schooi Lunch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014?2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich
products that are acceptabie to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least haif of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in aiiowing an exemption for the listed whole grain?rich product(s) for SY
2016-2017. Place an in the appropriate coiumn or columns (Yes) for each hardship consideration. If your hardship is

not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

 

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)?
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a significant
drop in meat counts after the whole grain-rich product(s) was
offered.

Whole grain biscuit

 

 

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost

 

Whole Grain biscuit

 

Yes

paiatability during the typical holding time.

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

Whole grain biscuit

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Whoie grain biscuit Pilisbury easy split whole grain biscuit I Pillsbury 63?) 902
Whole grain biscuit Whole grain biscuit . Richs 237390

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are avaitable upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least haltc of the grain items offered weekly is whole grain-rich.

Susan Baker 7/5/2016

 

 

Director of Schools Date
SCWC Program Coo?ihator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equai opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workiorce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

300 Sewer Building - Frankfort. Kentucky 40501
Phone: (502) 654-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, Mn Baker . as the duly authorized representative of Jenkins Independent School Digtrig Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring,
preparing, or sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in
this document pose a challenge in offering whole grain-rich products. in Section 747 of the Appropriations Act provides
?exibilities related to whole grains, sodium and ?avored milk for school year 2017-18.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017
SP 33-2016

Kmmd?r??k

KentuckyUnbridiedSpiriLcom awry An Equal Opponunity Employer 

Hardshipls):

List the type of grain productis) to
be exempted and attach
Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). [Ii

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

Pasta

 

 

List the type of grain productis) to
be exempted (attach production

 

 

 

 

 

 

 

 

 

 

 

 

 

Hardshipls):
record):
Poor student acceptability: The whole grain-rich productis) offered by Pasta
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain- 
rich productls) was offered multiple times and over a sustained period
of time.
Other hardship (please list):
List alternative product types! brands that have been utilized:

Grain Item Product Description Manufacturer Product Code 
Durum Wheat Spaghetti Noodles GFS Vendor Item Code
Semolina Egg Noodles 9390141370

Elbow macaroni 9390129234

[9390113320

snnicneo Biscuits Pillsbury 94562-32391
FLOUR. 1 . a Lassa-06235

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy at the Intormatlon prowcleo above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?9

 

 

Signature of Director of School Nutrition Program Date
6m brv'V/r
. Alla/4,: .. 

SCNNIC Program Coordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sendra.wagner@education.ky.gov

 

 

 

 



?Harman ?my An Equal Opportunity Employer MIFID

92$?

5?
a?
1?2. 1
Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19
I, Lee Ann Conner as the duly authorized representative of Jessamine Co. Schools Name], do hereby

 

 

attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipls).

a temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

My Signature Indicates that I understand and attest to the accuracy 01' the Information provrded above. ?13! all

records to support the information are available upon request by the State Agency, and that the exemption must

ensure that at least half of the grain items offered weekly are whole grain rich.

 

 

.gnature of Director of School Nutrition Program

Hardship(s):

DateList the type of grain produc?s) to

be exempted and attach

justi?cation documentation

(production records, receipB,

 

 

SCNIMC Program Coordinator

Date photos, etc.):

 

Please

Metal Mittec'ljt? cW??t bahdra.wagner@education.ky.gov

meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

am requesting a whole-grain
waiver for Waffles to be served 1
day every 3 weeks at the Middle 
High schools for lunch as part of a
"Chicken 8; Waffles? entree.

 

 

Hardshipis):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productts) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.

We are working hard to get the
students to trust us 8: try new
foods. We sampled in whole grain
waf?e during the 2017-18 year
during breakfast that did not go
over well. The Ginny's Waf?e we
are requesting to serve will be an
item that students will enjoy 8: it
will help us to increase
participation. The waf?es will be
served along with a Whole Grain
Breaded Chicken Strip.

 

 

Other hardship (please list):

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Intormatton prowoeo above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at ieast half of the grain items offered weekly are whole grain rich.

t?

gnature of Director of School Nutrition Program Date

 



Wo'?ram Cood?i?ator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

arde Jessamine Coun Schools
.. Karen . as the duly authorized representative of Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain prod uctls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardshipls):

List the type of grain productls)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The SFA's records demonstrate a signi?cant
drop in meal counts after the whole grain-rich product(s} was
offered.

 

 

 

 

 

Financial hardship: The SFA experienced a signi?cant cost
increase when procuring the whole grain-rich prod uctls).

 

 

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productts) in the local market and
would like to offer enriched grain itemls) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

WG Pasta Products, Biscuit

 

Yes

Hardshipls):

List the type of grain productls)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productls) was offered multiple times
and over a sustained period of time.

WG Pastas and Biscuit

 

 

 

Other hardship (please list):

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

Grain item Product Description Manufacturer Product Code
. /5 Spa?m Whn?c Gm ., :5 35.; 0
magma/w mm. a. (gr-g 01;qu
?9955 be; (6F, 1.42! 
.8150qu 1.) {ma 6m CF15 e3'45?7f/

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records

to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

14%4141 

Dire'ctdr of Schools

Dae

 

Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, Mawha 0016mm" ,as the duly authorized representative of johnson $91100}; Name],
do hereby attest that the aforementioned SFA and ail schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain rich products. In Section 751 .of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113~235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain- -rich requirement in the meal programs, in school years (SYs) 2014? 2015, 2015-2016 and
2016- 2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain- rich
products that are acceptable to 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at ieast half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain producth) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

 

Yes

Hardshipts):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financiai hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain~rich productls) in the local market and
would like to offer enriched grain itemis) temporarily.

?99 media

 

Emma

 

 

Unacceptabie product quality: The whole grain-rich productis)
offered by the SPA did not retain. the desired texture or lost
palatability during the typical holding time.

 

 

Hardshipls):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whoie grain-rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (piease list):

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

Pasta Win/hole egg noodle 911:8

242545

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

0% 2(82 [7
Director of'Sclaggls Date

Coord??tor Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandra.?agnangdugation.g.gov.

is an equal opportunity provider and employer.?

Page 3 of 3

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017?18

I, Angela Ledford as the duly authorized representative of Knox County Public Schools Name], do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017?18.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2015 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32?2017
SP 33-2016

(if 2?
(enluckyUnbridledSpirit.corn An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s). {El

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Whole grain biscuits
Whole grain rolls

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/ parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuit Easy Split WG Buttermilk Bakery Chef 8615121031
Biscuit
WG Biscuit Whole Grain Biscuit Dough Pillsbury 132268000
WG Biscuit Whole Grain Biscuit Dough Rich?s 49800093157

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the tntormatton mounted above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ens that at lea half of the grain items offered weekly are whole grain rich.

SignaqueW of Echool Nutrition Program Date 

Wor? 7129,77

Program Coordinat07 Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

:5
KentuckyUnbridledSpiril.com An Equal Opportunity Employer MlFlo

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19 .

I, Stephanie Utiey, as the duly authorized representative of LaRue County Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a

challenge in offering whole grain-rich products.

The Interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich prod uct(s).

 

limited product availability: The SPA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Whole Grain Pasta

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student's letters,
surveys, etc):

 

?r student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

 

 

Whole Grain Pasta

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

 

 

Product Code

 

 

 

 

 

 

 

 

 

 

 

my Signature Indicates that I understand and attest to the accuracy or the Information provrdeo above. that all
records to support the Information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Jl'tanham bb?pu, 7 7/ )3

Signal re oil D'Irector' of School Program Date

Mc?a/?t 
Program Coordinat?f Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@eduoation.ky.gov

 

 

 

 

 

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Tammy Hammock, as the duly authorized representative of Laurel County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain?rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

 

Hardship(s):

 

meal counts after the whole grain-rich prod uct(s) was offered.

 

 

. like to offerenriched 

texture or lost palatabilLty during the typical holding_time.

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).
imited?product availability: The Eli-A does not have access to a
compliant whole grain-rich product(s) in the local market and would

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired

 

 

Hardship(s):

.4 .

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received significant negative student/ parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Biscuit

WG Pasta

 

Other hardship (please list):

Bi?cuit: Attached are breakfast production records showing the
difference at our high school where we served 185 breakfast with wg
biscuits and 276 when we served the regular biscuit. Our high school
students will come to the serving line and see the wg biscuits and walk
away. Parents and students are complaining. See attached

Pasta: We have not served spaghetti in several years because the wg
was not accepted well by the students. We would like to offer regular
pasta to add variety to our menu and better serve our students.

 

 

 

 

 

List alternative product types/ brands that have been utilized:

 



 

 

Grain Item Product Description Manufacturer

 

WG Biscuit

Biscuit Pillsbury

Product Code

 

132265000

 

 

 

 





 

 

 

My Signature Indicates that I understand and attest to the accuracy or the intormatlon promoted above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Mirth/W yam/ma}, 

 

 

 

 

Signature of Director ?chool??lutrition Program Date
Am 6% at? 
Program Coordinaty/ Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Tammy Hammock, as the duly authorized representative of Laurel County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain?rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

 

Hardship(s):

 

meal counts after the whole grain-rich prod uct(s) was offered.

 

 

. like to offerenriched 

texture or lost palatabilLty during the typical holding_time.

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).
imited?product availability: The Eli-A does not have access to a
compliant whole grain-rich product(s) in the local market and would

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired

 

 

Hardship(s):

.4 .

List the type of grain product(s) to
be exempted and attach
justification documentation
(production records, receipts,
photos, etc.):

 

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received significant negative student/ parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

WG Biscuit

WG Pasta

 

Other hardship (please list):

Bi?cuit: Attached are breakfast production records showing the
difference at our high school where we served 185 breakfast with wg
biscuits and 276 when we served the regular biscuit. Our high school
students will come to the serving line and see the wg biscuits and walk
away. Parents and students are complaining. See attached

Pasta: We have not served spaghetti in several years because the wg
was not accepted well by the students. We would like to offer regular
pasta to add variety to our menu and better serve our students.

 

 

 

 

 

List alternative product types/ brands that have been utilized:

 



 

 

Grain Item Product Description Manufacturer

 

WG Biscuit

Biscuit Pillsbury

Product Code

 

132265000

 

 

 

 





 

 

 

My Signature Indicates that I understand and attest to the accuracy or the intormatlon promoted above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Mirth/W yam/ma}, 

 

 

 

 

Signature of Director ?chool??lutrition Program Date
Am 6% at? 
Program Coordinaty/ Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hal Heiner

Matthew G. Bevin Secretary Governor Education and

 

Workforce Development Cabinet

Stephen L. Pruitt, 
Commissioner of Education KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower Phone: (502) 564-3141 - 500 Mei-o Street - - Frankfort, Kentucky 40601

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, _Tammy as the duly authorized representative of the Laurel County Public Schools, do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to whole
grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SPA can demonstrate hardship(s). The
exemptions are allowed for any type of grain producttsi, pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains offered
weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the Eisted whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016, may
continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32-2017
SP 33-2016

KW UNERIDLEMD SPIRIT &yf%

KentuckyUnbridledSpirit corn An Equal Opportunity Employer MIFID

List the type of grain productls) to
be exempted and attach
iustification (pictures, receipts,

etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich productis) offered by the SPA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to

Hardship(s):

be exempted (attach production record):

 

Poor student acceptability: The whole grain-rich product(s) offered by W6 Biscuit
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain- rich
product(s) was offered multiple times and over a sustained period

of time.

 

Other hardship (please list):

May 2016 we served 3514 breakfast that included the regular
biscuit, August 2017 we served 3386 that included the wg
biscuits. a difference of 128. at our high schools the difference
was 222 breakfast. Our high school students will come to the
serving line and see the biscuits and walk away. Parents and
students are complaining. See attached

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

WG Biscuit Biscuit Pillsbury 132268000

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
revupport the int rmation are available upon request by the State Agency.



Date

    
    

 

Signature of Direc 0 School Nutrition Program

.Zg? /6 ~04? '0

l?5rog'ram C?dinator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.kygov

Kent at??

KentuckyUnbridledSpirit.com An Equal UNBRIDLED ?my Opportunity Employer IWFID

 

Ha: Rama:

Smmtary

anti

Warkfama Bavaiagm?m ?aking

?a?h?w 8mm
Qavgmar

 

si?ghan $353334.
a? Edasa?m



mama ?Wm: 5% ?aw Sing? a ankfis?, 
?aw: a 

Reqaast 'er Examptian far Whafa Requirema?t?
Salami Yea? 

?faresa Themas Lam mus-gig km 
if, 35 Elke {Sui}; w?m?m? rapfasanm?va nf Name; {?at harem a?est

was: the afaremaa?anad 393:; Md a? ashmis made-r ?ts iuris??n?a? demma?tmm a hardship in maturing, wegaring, a?
gawiug mmp?am wkc?e gram-rich pm?uctg that am aacagzta? ha; am; that aha famiam intimate-ii $31 ti?s ?mvmant
gage a cha?mg? {3393*ng whaie gramwith gm?a?s, Sea?m ?m a? the Apgmmia?ans m: pmvi?as ?exibi?tias minted ta
w??ia grams? m?ium and ?awm? miik far aha-? yew Emma

KWKQE may mgr-mire an ammp?tm ma?axi is}? isg?aai?a?: gm?am? ihg 3% tag?: hamshipisi. Th3
axemptien? aw a?awa? ft): 3:35: Wga gram gastag mmtrimaran: 
gramm! S??s granm? ammp?m ms: amngiy with aka mg?mmem as? at teas: ha}? af aha grain-s
mffamsj week?y am w?a?e gain-?nk 3&de

w?i kardship fantam in s??awing an axamgi?m far aim 3mm: Ma?a graiwrig? madact?} for tha Riki?l?'
?g?zmi year. ?aw an in ma apgrag?ate miamn a! ca?zmm far am?! hard??gs mas?gra?m? if yaw hardshig is 39:
indude in tha ?he; har?shiy magma, L553: ti?m grain ym?u?ia} in he examgtezi,

Q?ggmma?: axmasiang 3313?17":

gag: axsmp?ms agpmved the ?ivi?i?? Sah?ai anti C?mm?niw Nairitian, WE, SF ?ami?, Exemptian ?ame:
magma far Exemptiaas mg 3mm Maaiig? Whaie ?mim?im fa? k?m? ?war E?i?nl?? A9363 29,, 2915,
may gamma tank: the tafm? by megs were apyrm? mmugh mxmg.

*?afagence: 32?2335?
$9 3343315

gm wag? Emgi?wf 

 

 

 

 



55.35:; the mm 9f gram yredu?m is:
$3123 anei a?agh
ims??mtim ipiaimaa, ramigm
31;; ?ammaata?m}:

 

?nan?a? kard?hm: ?ma recar? d?ma?smm a ?gnifimm 533;} if:
mea? cm?s afiar the wh?a gm?iwriitk gmm?fs? W33 aggra?

gamma? amtab?a is mm mm ms: mam ?sh-ea

 

?nanci? hm?shig; ?me 55% ?xger?mmd a ?ga??mm mat incrgaga
w?en gram??g {ha whaafa gra?w?ch gmdaa?s}.

me m5: whaia gram mdwcia 23533 men

 

iimiteci map-?aw: ma 53$: ham amasg a
mmg?m: mm gyamanrich pm?a?ig} in the 343533 ma?a: we; wgga?si
aka gaffer earighe? gram 


Rama?:




 

?aw-mam ?ardshig: unamapmi?s mama gua?ty; Maia
gm?wr??i a?eyai? by 3333 51% $32 as: {?22335 
2mm {x 3&3: ?m?ag i?a taggmi ?ai?iag {Ema

 

 






 

?awghipis}:

{35% {vim 9% gmin pm?uetis} tn
he ?xamg?e? {awash 
mam-m:

 

?mmt atmgta??ty: Tim Ma?a gmina?ah gmi?um?'e?am? by
the SEA waamd magma ?ada gamma: f?a??atk :33? mam
was 523% mag 3% ma: mam 3mm wh?a EM Ma?a gm?mm
was; a?are? maSiiga-ie ?rm-5 aa? war a ?aatatimd w?mf



ga?ta ?shes arm? ascegm? wig;
w?h :53ng Wm?! a am i:
?aa??i ?ak; wag gas 31mg: and
?aky am! wasn?t mg agm?zing
Wage :33" {he brawn mt

 

mm hardshig i?aass 

 

ma?a gram gmic??gh
?ra?zkam with maps has
Magma mam; sinw wa mm
ram ?nd mm gram if}


 

 

?355? aitaraa?ge gm?mz typesfiamad? that haw been u??m?r

 

 

 

grain item 9mdss? ?ascrimim a?amfa?wm Fr?iiz??f ?anks
mm gain swam: 53% Sgaghai? ?asia 3% tag Sak?ia Gmwam 8?38??1322
mm mm mm?, 53% Eihaw mammi 52mm m: gags sakaia @?387921 

 

 

 

 

 

 

 

 

  
 
 

My ?gmma?e iadiaa?as thai mdarstan? and attest in mg amragy 1:3? am ??f?ma?m garmi?eai abwa 'gh-a: 
gamma {a sappa? ii? iafa?na??n am avaiia?la agar: 3mg- Agamy?

7

saw}? Nut??ian ??mgiam 3.223%

a?

1/454 x" gawk?

g?m C?g?in?r mm

   

 

   

gig

 
 

3%

 

 
 

 

P?easa mmgsiaia {mg Sig}; sa?mii Sam}? Wagrgaf a: 

 
   

$2 wag? Emig?myar wga

W.

 

Hal Heiner

 

Matthew G. Bevin Secretary
Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capitai Plaza Tower 0 500 Moro Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 . 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
Teresa Thomas Lee County Schools
1, as the duly authorized representative of Name]. do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing. or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
schooi year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 201647:
All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:

Request for Exemptions from the School Meals? Whole GrainiRice Requirements for School Year 2016-17, April 29. 2016.
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32?2017
SP 33-2016

A
enfude 
An Equal Opportun MIFID

KentuckyUnbridiedSpiriLcom UNBRIDLED 

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.



 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

cost of serving whole grain is higher.

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

GFS only has 1 whole grain biscuit on the bid
and it isn?t that good and when baked it looks like
an hourglass. doesn't bake up looking appetizing

 

Preparation Hardship: Unacceptable product quality: The whole
grain?rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during_ the typical holding time.

 

students want a white biscuit
and white rice

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain?
rich product(s) was offered multiple times and over a sustained period

of time.

we have used the rice. biscuit and crackers
for the past few years with negative
feedback from students and staff. We could
not ?nd another product with 
vendor to even try. These items have been
thrown away orjust not chose on the line.

 

Other hardship (please list):

 

the biscuit bake up and don't look
like like hourglass.
The brown rice isn't a good product
and we haven't been able to ?nd
another that is acceptable and
approved. 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuit 2.5 oz. frozen dough Pillsbury 94562-32268
Mexican brown rice whole grain Mexican brown rice ?empreasson Foodseroun 
miniwasamnwackers .39 oz. ind package Kellogg's 3010010088

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all

records to supportt information are available upon request by the State Agency.
of, 08/22/2017

Signature of DirEEto?r of School Nutrition Program Date

 

A424 

l5rogram C'oordip?tor Date

 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

a?ee?a?e

KentuckyUnbridledSpirit.com UNEHJDLED Hwy An Equal Opportunity Employer MIFID

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a compteted waiver request form for each individua! pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: Lee County Schools

Name of Product a waiver is being requested for: Whole Grain Lasagna pasta noodles

Brand Name of product used:

Recipeis) in which the product is used: Beef and Cheese Lasagna

Other products tested: 

Issues with products used and tested: No whole grain lasagna pasta available on bid or in stock at
Gordon Food Service.

Internal Use Only

 

Date Submitted: 
Date Approved: (gr ?w 
Mm WW
mm Matthew 

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016-2017

iNOm (1m {86 IA L?s. as the duly authorized representative of [Eh/Le in panjuSC-Loa Iii?[513A Name],

do hereby that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring
compliant whole grain- -rich products that are acceptable to students and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich
products that are acceptabie to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain~rich product(s) for SY
2016?2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain productis) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardshipls):

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich product(s).

 

Limited product availability: The SFA does not have access to a
compiiant whole grain?rich product(s) in the local market and
would like to offer enriched grain itemis) temporarily.

 



 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SFA did not retain the desired texture or lost
paiatability during the typical holding time.

 

 

List the type of grain product(s)
to be exempted (attach

 

 

 

 

 

 

 

Yes Hardshipls): production record):
Poor student acceptability: The whole grain?rich product(s) 0' CL W1 ?16)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item Cu Hr
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.
Other hardship (please list):
List alternative product types/ brands that have been utilized:
Grain item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whoie grain-rich.

9M i1_ 931??:



Director of??choois 6 Date

Waco. I - .. 

SCN/M??Progra n?hoordinator

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer."

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF 

Capital Plaza Tower I: 500 Mero Street Frankfort, Kentucky 40601
Phone: (502) 564-3141 I 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

 

. as the duly authorized representative of . 323%? Name], do hereby attest
that the afo entione SFA and all schools under its jurisdiction demonstrate a ship in procuring, preparing, or
serving compliant whoi grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products. in Section 747 of the Appropriations Act provides ?exibilities related
to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain?rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2015 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. if your hardship is not listed, include in the other hardship section; List the grain product(s) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017?18.

*Reference: SP 32-2017
SP 33-2016

mind?Fit


KantuckyUnbridiedSpiritcom UNBRIDLED ?my An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardship(s): record)?

 

Poor student acceptability: The whole grain-rich product(s) offered by Crackers, noodles, biscuits
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy at the tntormatron prowded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

7 0? l5] l7

 

 

 

 

 

 

Nutrition Program Dita 
/0 
Program Coordinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.kygov

5
KentuckyUnbridiedSpirit.com Kgg?lmmy An Equal Opportunity Employer MIFID

 

Matthew Bevin Stephen Pruitt, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Meta Street a Frankfort, Kentucky 40601
Phone: (502) 564-4770 . 

Request for Exemption for Low-Fat Flavored Milk
For School Year 2017-18

Tiffany D. Felty 

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(c) of the ApprOpriations Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk
fat) flavored milk through the NSLP and the SBP 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.

Documentation Submitted
(invoices, waste study,
Hardship(s): production records, etc.)

 

Signi?cant decrease in milk sales since implementation of the
current meal pattern. 

 

Declining milk sales despite offering alternative products and
brands.

 

A food waste study indicating 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 the
palatability of fat-free, flavored milk.

 

 

 

 

 

KentuckyUnbridledSpint.com An Equal Opportunity Employer MIFID

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency.

 

 

Tiffany D. Felty 10/23/2017
Signature of Director of School Nutrition Program Date
A proved Program Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at Sand ra.Wagner@education.ky.gov

is an equal opportunity provider and employer.?

Page 2 of 2

Hal Helner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, Cathy Pleasants as the duly authorized representative of Lincoln County Food Service Department Name], do
hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring,
preparing, or sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in
this document pose a challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides
flexibilities related to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

Md? 5 
KentuckyUnbridledSpirit.com ?11,wa sprang An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s). El

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Whole Grain Biscuit, Whole Grain Roll,

 

 

Other hardship (please list):

 

 

List alternative product typeslbrands that have been utilized:

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Southern Style Pillsbury 618152
Roll White Roll Sister Schubert's 494385

 

 

 

 

 

 

 

 

way alglluu?c I Ulluc?lalallu dllu ducal lU Lllt: bill
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich

?ff/46! ?ag/M 777' $161!?

Signaturep] Director of School Nutrition Program Date



l5'rogram Coo?'dator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

[(91sz git

KentuckyUnbridledSpirit.com ?Hammer, Emmy An Equal Opportunity Employer MIFID

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

isj?mye E). Kci. as the'duly authorized representative of [?Ute?cr?x {fa ?ciwia Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain~rich products that are acceptabie to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015,. 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the iisted whole grain-rich productis) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, inciude in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes



List the type of grain productis)
to be exempted and attach

justification (pictures, receipts, .

etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grainvrich productls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the iocal market and
would like to offer enriched grain item(s) temporarily.

WHAW





 

 

 

Unacceptable product quality: The whole grain-rich product
offered by the SFA did not retain the desired texture or i st

Pic}. fa will} so if" a? ?7



   

 

paiatability during the typical holding time.

 

 

Yes

Hardshipis):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis}
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich producds) was offered multiple times
and over a sustained period oftime.

Elie-i tofu?. .

12" ?7,151?
wg?tghutgh} {23? pawl?; 15:53:
D?itizemc?mwn f5 of?cer?. flag.-
g? 5m} Let; acumen timer-i beau-mt

 

 

Other hardship (please list):

 

l4 56 ?9596.- ?fB Pom?
eh aim!? (may) mt: f: +7

 

?ue}

526.55% 

 

 

List alternative product types] brands that have been utilized:

 

Grain item

Product Description Manufacturer

Product Code

 

Bi Silt) If?

52:4;me awayiietart win ?22 team

La :2 a: a

 

 

 

 

 

 

do?SlalgmBet-c cry 37 
5616'?: f? Lil; Bi BUU Kieth 



 

 

Page 2 of 3

a; y:

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that ait records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

M%W?dd M) do! ?73! 

 

 

Si-?n?ure of Dite?tor of? Schools Date
L- 

W?e/ Q. [gm/Q
Program Coordj?'ator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandra.wagner@educationkygou.

is an equal opportunity provider and employer.?

Page 3 of 3

Logan County Schools began using whole grain biscuits the year that all breakfast Items had to be 100%
whole grain. The elementary/middle school students did not care for the whole grain biscuits. We
continued to use this whole grain biscuit until the 2015-16 school year when we went with a whole grain
slider bun for our breakfast sandwiches. Although there was slight Improvement in student acceptance,
the slider bun was still not a big hit.

The following documentation is for'the whole grain biscuit dough that we used up until the 2015?16
school year.

Wagner, Sandra - Division of School and Community Nutrition

From: Wagner, Sandra - Division of School and Community Nutrition
Sent: Tuesday, March 31, 2015 9:56 AM

To: Bisig, Juanita - Diocese of Louisville

Cc: Bartenfieid, Sue Nunn - Division of School and Community Nutrition
Subject: Whole Grain Waivers

Juanita,

in order to approve your whole grain waiver request we will need you to provide some more information.

We will need you to enter the other product types/brands that you have tried at the bottom of page two to the
exemption request form.

We are also requesting that you provide us with a week of menus from the month of September for the school
years 2013 and 2014, as well as production records from these same weeks to show the decline in acceptance of these
particular products.

Feel free to contact me if you have any questions regarding these requests.

Thank you,

5m} Mtg/(er was an

Program Coordinator

Kentucky Dept. of Education

Divisionof School and Community Nutriiton
(502) 564?5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or patental status, sexual orientation, or if all or part of an individual?s income is derived from any
public assistance p1ogram, 01 protected genetic information 111 employment or in any program or
activity conducted or funded by the Depa1 tment. (Not all piohibited bases will apply to all programs
and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Prog1am
Discrimination Complaint Form, found online at

ascr. usda. govlcomplaint filing cust html, or at any USDA of?ce, or call (866) 632'9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at US. Department of Agriculture,
Director, Of?ce of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 20250-9410, by
fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 877 '8339; or (800) 8456136 (in Spanish).

USDA is an equal opportunity provider and employer

 

Steven L. Beshear . Terry Holli'day, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION
"casual Plaza Tower . 500 More Street 5?Frankf0i't, Kentucky ?40601
Phone: (502) 564-4770 - ww.education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015?2016

i, Juanita Bisig as the duly authorized representative of Archdiocese of Louisville School Lunch Program do hereby
attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant
whole grain?rich products that are acceptable to students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain?rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015-2016,

to a school food authority ism) that demonstrates a hardship in procuring compliant whole grain~rich products that are

acceptable to students.

The State Agency may approve an exemption request for specific products ifthe SFA can demonstrate hardshiphs).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for
the remainder of SY 2014-2015 and 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted. - -



 
 

I An Equal Opportunity Employer MIFID

. WERIDLD- SPIRIT .

 

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productis) was
offered.

 

Financial hardship: The SFA experienced a signi?cant'cost
increase when procuring the whole grain-rich produc?ds). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
paiatability during the typical'holding time.

 

 

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich producds)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich producds) was offered multiple times
and over a sustained period of time.

Sandwich bread, hotdog buns,
hamburger buns, tortillas, biscuits,
dinner roils

 

 

 

Other hardship (please list):

 

Participation has dropped
dramatically.

32,812 fewer students eating since
we started serving whole grain
products.

 

List alternative product types/brands that have been utilized: 

 

Grain item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State agency} and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly IS whole grain rich.

WM Wad"

 

 
    

Signature of Director of S?hdois Date
03 - 940 male/5?
proved Program Manager Date

*Please complete this form, Sign, and electronically submit to Sue Bartenfleld at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

Raquest fer Exemptian fEIr Whole Grain-{Rich Requimments
Schcal Year 2Q16~2i317

   

.35 the {ini {amen EenEaEive {Ei?s 11 Cl: name)
{it} hereby {hat {he SFA and I {than 5 made: its {EamonstraEe IE harrirhip in {1me Eng
whale grain- are: aEEeptabie IE: the 53(1an In {his {incumant
{wise chalEnge {Eng whole grain {iEh . In 2?51 {If the CmIsolidaEi-Ed {End Comim?ng
AEE 2015 {Public Law 3113 235) Congress {ii {muted {If Ag?mimm aiiaw Stan-E 
administer the Malia-{ml {it ?hEmi L?f?El'Ih {Em-gram {131g SE Emmi giant {In {Examptim

 

203? schm?i {mid (SEA) a hardship in {Re?ning whnie gram {iciI
that {Ere EtEEdE-gms.

The State Agency may approve an fEEr {age-{HIE If the SEA {an hardshipig};
exemplEEm-E are {?awed {Er any type, 0i grain pt?oductisi {?2.11 pasta, bi??d brawn rice, Jami for 
or maria {iifierE?E-nt precincts. SEAS granted. mam war}: wiEh the Slate: Agency tn Search. {<35 
and must {0:11in with the SE 2013 2014 mquirenmnt {If {If the grains weekiy {Ire whoie
gram pradEIEts

HIE State Aganmg hardship factors in alicswl?g {In it}: the HE Zed whoie gIain rich producttsi f{.Er 33'
263.6 2.01? PlaE {In x? in the appropriate wlumn {Er {:?E?Eiumns (Yes) {En each haraship- cansideratian. IE hardship is
{mt Ham-{i {name In the {Ether hasd?hip the grain prmiuctis 10 {Exempted

SP 33-4316

Page 1 {If 3

 

Yes

oiiemd

 

Lit-5555552 perU-tt 

 

Ha-rd5hipis):

List the type of grain 122251515515]
:55 be exempt?d arid attach
Justification (mantras, 2525-3555,
at; far {lamitnentatian}: I

 

 

Financial. hard-5MP ilw retards denumm?iu a} 
drop if: 22125315 minute after the Emit-Ts [52252155 lifh pmduciisi was

 

hardship: experiuntad 2 significant msiII
in?ame whim pmmring the whale grain rich. produc?s).

152551555 15555 5 
1? 

 

 

wnuid t0 Gift?! gg?iriciiuigmm Ila-mi: i_}_emgomfiiy

Unacceptable pro?u? quality: 5512212 gria I??i rieii 55555255552}
{affemd by ihE did 555321; i?i?zin the dagirad texture or inst

 

555555.55 55-5555.

. SPA gin-5'55 n?i 31222255225550 3 I
agnipliani wiwi? grain- rig-5h pmductisi in the imal mag-i221 and 

 

iui?ii?t 5,

 

Riki! #1506? {.2141 ?ff/5&5

 



 

 

art-51mg: 2 suatai?ed {maria} (if time

 

 

P22: Student acteptabiliw:

offered [5?2 5555. 555555555555 signifizant neg-25122 
{225113251}: 05 215225 was increased pi ate wasm (if that menu item
wil?z?i the whale graln- graduatis) was taffeta! "1551525155 H5225

mine: hardship {52122555 list):

 

 

Than-hole grain rich .

 

I: ixi'?z?i?? 2615515555 iiE225?
dough

List the type {if grain pmdua?s)
It: be 2225515515551; {attach
production regard]:

 

 

 

 

 



552222 item

E5235 5 (El

   

 

Praduci Cadiz 

 

 

 

25:25 13:5

 

 

2Fill

 

 

 

 

E15155 

Page; 2 2i 3

  

 

 

 

 

  

 

WI {255?
325155555

hi5, {Am}

 

My gignature de-cate-s that 3 untierstant} am! ante-st it: the accuracy; of: the informality" prmided gimme. that at} recu-rcis
the inframmtimz are: avaiiahfe upnn request by the State Agetzty, and that the}: 5m receiving the examp?on
mug! ensure thalyat lama: half 0f the grain items af?xed weekly is wh?l? 

   

?zz/h 4?70??



Pro?ram {aardig?r? Date

*Si?iaa-ge ca-mpiete this form, sigra, and gubmit ta Sandy Wag-mar at 

 

?s'an equak pruv?der and employer?

Page 3 a? 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mero Street Frankfort, Kentucky 40501
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, 411??) d/er . as the duly authorized representative ofwa?i-?A Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for specific products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33?2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

COITI Km An Equal Opportunity Employer MIFID

List the type of grain productls) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

Hardshipls):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain productls) to
Hardship(s): (attach production

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received signi?cant negative student/parent feedback or there 
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

W401 Sim/(475 ifs/Id 0:4,ch survey: 6w! Mi: 
?of nib/t 9?an w; ?Jr (vied
For {7th tum/er Me yun/z'an "Wr? Sign ?1;?th
yr? Ah {a Re gamed or; ?nal,

 

 

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
V6 5am Margy bm 1,54: 61:54?qu 
limit is 6 to:- bw/ 65% 5/5/20
W6 5W (19750.?? Mrf/fj 5cm 5/7735

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the tntormatlon proytoeo above. an
records to supp rt the infor are available upon request by the State Agency.

[Mi? 

   
 
 

 

 

 

 

nature of Director of School Nutrition Program ?e/Dat
7722/7

Program Co?inator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky gov

K9 Jay
com ?mm? An Equal Opportunity Emp-oyer MIFID

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street 0 Frankfort. Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

. 9 Marion County Schools
l, Jenmf l' Wheeler, as the duly authorized representative of Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SEA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32?2017
SP 33-2016

K931113573

An Equal Opportunity Employer MIFID

KentuckyUnbridledSpiril.com

List the type of grain product(s) to
be exempted and attach
justi?cation (pictures, receipts,

Hardship(s):
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant dr0p in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

 

 

 

 

 

 

 

Hardship(s):
record):
Poor student acceptability: The whole grain-rich product(s) offered by a at a
the SFA received significant negative student/parent feedback or there Rice
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.
Other hardship (please list):
List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code

 

Whole Grain Pasta Kitchen Essentials Fame-Spaghetti and Macaroni Kitchen Essentials 654560/654550

 

Who e Grain Rice Wh in Rice Par Boiled long grain (Gardens Choice) FS 722987
Mexican Long Grain (Gordons Choice) FS 556670

 

 

 

 

 

 

 

 re'co'tlas to support the information are available upon request by the State Agency.



@hature of Director of School Nutrition Program Date



Program Minster Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

Kent 333%:

KentuckyUnbridledSpiril.com An Equal Opportunity Employer MIFID

Hal Heiner

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower 0 500 Mere Street - Frankfort, kentucky 40601
Phone: (502) 564-3141 0 
Request for Exemption for Whole Grain-Rich Requirements
. School Year 2017-18
Marion Coun

l, Jenmfer Wheeler. as the duly authorized representative of ty Name], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain?rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibillties related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SPA can demonstrate hardshipis). The
exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is not
listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extensions from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33?2016

ease

KentuckyUnbridiedSpirit.com An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach
Justi?cation (pictures, receipts,

Hardship(s):
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palata bility during the typical holding time.

Whole Grain Crackers
Whole Grain Biscuits

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardship(s): record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Whole Grain Crackers
Whole Grain Biscuits

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer Product Code

Whole Grain Crackers Zesta Crackers Keebler 190241 (GFS)
Whole Grain Biscuits Pillsbury Biscuits Pillsbury 618152 (GFS)

 

 

 

 

 

 

 

 

 

 - ?a nun? -. .. .mo- cp- - 

records to support the information are available upon request by the State Agency

?was wit?e Q/fo/l/

mature of Director of School Nutrition Program Date

?'77

Date

 

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov


Kenlude 
An Equal Opportunity Employer MIFID

KentuckyUnbridledSpirit.com 

ption for Whole Grain?Rich Requirements

Request for Exem
School Year 2018?19

as the duly authorized representative of Marshall County School District Name], do hereby attest
ols under its jurisdiction demonstrate a hardship in procuring, preparing, or

I, McKenzie SuiterI
hat are accepted by students, and that the factors indicated in this document

that the aforementioned SFA and all scho
serving compliant whole grain-rich products 
pose a challenge in offering whole grain?rich products.

nd 226 extends through school year 2018-19 the

The interim ?nal rule from 7 CFR Parts 210, 215, 220 a
hole grain rich with an appropriate waiver.

menu flexibilities giving the option to serve grain products which are not 

exemption request for speci?c products if the SFA can demonstrate hardship(sl.
fgrain product(s), pasta, bread, brown rice, etc.) and for one or
work with the State Agency to search for acceptable products,
least half of the grains offered weekly are whole grain-rich

The State Agency may approve an 
The temporary exemptions are allowed for any type 0
more different products. SFAs granted an exemption mus
and must comply with the SY 2013-2014 requirement of a

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018?19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

rl/



?l

I:

 

List

cook/baker.
Other hardship (please list): 
alternative product types] brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
Tortilla 6 inch pressed flour tortilla La Fronteriza 702633

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

records demonstrate a signi?cant drop in

Financial hardship: The 
meal counts after the whole grain-rich product(s) was offered.

 

 

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

 

 

 


Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would

We are contracting with GFS, they do
not offer a WG tortilla.

 

like to offer enriched grain item(s) temporarily.

 

?paration Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
?xture or lost palatability during the typical holding time.

 

 

 

 

 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

GFS is not offering 3 WG tortilla.
Students prefer a non-whole grain
tortilla. From previous use of a WG
tortilla, they stick together making
preparation dif?cult for the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hardship(s): Pizza

List the type of grain product(s) to

be exempted and attach
justi?cation documentation
(production records, receipts,

photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

Loss of student participation

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain?rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardship(s): Pizza

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,

surveys, eta):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period

of time.

WG pizza company that was
acceptable to students went out of
business. With student taste testing
the Alpha Foods non wg pizza was the
favored pizza by the students.

 

Other hardship (please list):

 

 

To keep cost down the district prefers
to do commodity processing. After
student taste testing and choosing
from a pizza that is available through
processing the Alpha Foods non wg
pep and cheese pizza was the selected

by student.

 

 

List

 

 

 

 

Pizza Pep Garlic Butter Pepperoni Alpha Foods

 

 

alternative product types/brands that have been utilized: Giorgio wg pizza
Grain item Product Description Manufacturer Product Code
Pizza Pep Garlic Butter Cheese Alpha Foods SP-162R
AP-164R

 

 

 

 



 

 

 

My Signature Indicates that I understand an
records to support the information are avail

attest to the accuracy or the Inrormatlon provrded above. that all
ensure tha least half of the grain items

able upon request by the State Agency, and that the exemption must
offered weekly are whole grain rich.

  

7/01?
ate

mas/e 

I Program Coorgl?tor Date

Signature df?UireE?tdr of School Nutrition Program

Please complete this form. sign, and electronically submit to Sandy Wagner at 

 

Steven L. Beshear . Terry Hoiliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE-DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Toner . 500 More Street a; Frankfort, Kentucky 40601
Phone: (502) 564-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016 

i, Beth Cunningham, as the duly authorized representative of-Marshall County School District, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015?2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptable to
students. 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 201341014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in ailowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be
exempted.

 

KentuckyUnbridiedSpiritcom

  

I . I i 

.- An Equal Opportunity Employer MIFID

 

Yes



List the type of grain prod uct(s)
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

Whole Grain Biscuit

 

Financial hardship: The SFA experienced a significant cost
increase whenprocu ring the whole grain-rich prod uct(s). Ei

 

Limited product availability: The SFA does not have access to a,
compliant whole grain-rich productis) in the local market and
would like to offer enriched grain itemis) temporarily.



Crackers Zesta Minir-

 

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SFA did. not retain the desired texture or lost
during the typical holding time.

Whole Grain Biscuit 



WG Cracker Zesta Mini

 

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain~rich productis)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich productls) was offered multiple times
and over a sustained period of time.

we Crackers Zesta Mini 



Whole grain biscuit

 

 

 

Other hardship (please list):

Burrito did not have a wg one on co op bid

 

 

 

List alternative product types/ brands that have been utilized:

 

Grain Item

Product Description Manufacturer

Product Code

 

Burrito

Burrito Foster Farms

10131 see attached doc.

 



RalcorplConAgra_

 



 

 

Crackers

Sunshine Harvest Wheat General Mills

 

 

114378 see attached

 

 

 

Page 2 of 3

 

my signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.



Date

Sign ture of Director 0 choois

3"3-75?

App oved Progr Manager 
4L4 C: 

ease comp 

ronicaliy submit to Sue BarteDer:ld at sue. bartenfield@education.kv gm:
is an equal opportunity provider and employer.?

  
    

  
  

 

Page 3 of 3

 

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
and School Breakfast Program through the school year 2016?17. All temporary flexibiilties approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency. 

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productls) for the
2016-17 school year. This extension will be in effect for the 2016-17 school year and the SPA is responsible for ensuring

availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 11017-13 school vear.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/bra tried in the proper columns below.

 

Grain Product for which Continued Hardship (Financial Other Whole Grain
an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. Poor Student Acceptability, Other) Tried and Were not Accepted

 

MW Mw??

 

BM raw mew, I 
- dual 003. MM
8W y?w 12%de ?aw mm WW

 

. 4M3. Won-W
awweww

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

?5 mi ?Wag/a
Director of Schools Date



Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 1 of 1

Hal Heiner

 

Matthew G. Bevin Secretary
Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower . 500 Marc Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
Marcie Hale 

as the duly authorized representative of Name], do hereby attest


that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ilexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

SCNIKDE may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productls], le.g., pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exam tron must comply with the (Si! 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017118
school year. Place an in the column or columns (Yes) for each hardship consideration. if your hardship is not
listed, include in the other hardship section. List the grain to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Relerence: SP 32-2017
SP 33-2016

KentuckyUnbridladSpiritcom mvemoceo SP, 311% An Equal Opportunity Employer Nt

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain productls) to
be exempted (attach production
record]:

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Whole grain biscuit, pasta,
whole grain tortilla

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
wg tortilla tortilla shell Azteca 06209
wg pasta spaghetti Dakota Growers 6738792021
wg pasta rotini GFS 867850

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
rec to uL?rta?? the nformation are available upon request by the State Agency.

I/Mx?u 3?29 7

Sig ature of Director of School Nutrition Program Date

5? 0791/7

SCWC Forgi?am Coordir?r Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

HESS
KentuckyUnbridledSpiril.com An Equal Opportunity Employer MIFID

UNSHIDL ED 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, PM). 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mere Street a Frankfort. Kentucky 40601
Phone: (502) 564-3141 I 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, Leah Feagin as the duly authorized representative of May?eld Ind Name], do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

?Reference: SP 32?2017
SP 33-2016

corn Km assume mam;;yh An Equal Opportunity Employer MlFin

 List the type of grain productts) to
be exempted and attach
justi?cation (pictures, receipts,

Hardship(s):
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The EPA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole 
grain-rich productis) offered by the SPA did not retain the desired
texture or lost paiata bility during the typical holding time.

 

 

 

 

List the type of grain productls) to
be exempted (attach production

Hardshipts}: rec d)
or 

 

Poor student acceptability: The whole grain-rich productis) offered by Pizza
the SPA received significant negative student/parent feedback or there Biscuits
was increased plate waste of that menu item when the whole grain-
rich product?s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

WG Pizza Pizza cheese Conagra 24824
we Biscuit Biscuit Dough Peach Valley 10530

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all

record support Tmauon are available upon request by the State Agency
Lot 28{ ?7

?ignature of Director of School Nutrition Program Date

 
   

A 7? <5 '1 1?
Program CoordInatordV Date

 

SC

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Km An Equal Opportunlty Employer 

Wagner, Sandra - Division of School and Community Nutrition

From: Wagner, Sandra Division of School and Community Nutrition
Sent: Monday, April 20, 2015 12:36 PM

To: Holland, Leah

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition
Subject: WG Exemption 

Leah,

We received you request for an exemption from the whole grain rich requirements for your Domino?s Pizza.

This request has been denied.

We do not feel that we can grant an exemption for a commercial product such as this, as it might appear we
were endorsing this product.

Let me know if you have any questions, and feel free to apply for a an exemption for other products that you
are having hardship with.
Thank you,

(fa/rag; Myra/6 5/ch

Program Coordinator

Kentucky Dept. of Education

Division of School and Community Nutriiton
(502) 564-5625 ext. 4946

The US. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or parental status, sexual orientation, or if all or part of an individual's income is derived from any
public assistance program, or protected genetic information in employment or in any program or
activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs
and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complaint Form, found online at

filing or at any USDA office, or call (866) 632-9992 to
request the form. You may also write a letter containing all of the information requested in the form.
Send your completed complaint form or letter to us by mail at US. Department of Agriculture,
Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 202509410, by
fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 877-8339; or (800) 845-6136 (in Spanish).

USDA is an equal opportunity provider and employer

   

Steven Beshear Terry Hoiliday, 

Governor Commissioner of Education
EDUCATEON AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION
. 0 Capital Plaza Tower . 500 More Street 1: Frankfort. Kentucky 40601
Phone: (502) 564-1770 a 

9



Request for Exemption for Whole Grain~Rich Requirements
School Years 2014?2015 and 2015-2016

I, Leah Holland, as the duly authorized representative of Mayfield Independent Schoot Nutrition, do hereby attest that
the aforementioned SFA and ail schools under its jurisdiction demonstrate a hardship in procuring compliant whole
graiwrich products that are acceptable to students, and that the factors indicated in this document pose a chatlenge in
offering whole grain~rich products. tn Section 751 of the Consoiidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to atiow State Agencies that administer the
Nationai School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the reguiatory
whote grain-rich requirement in the meal programs, in schoo! years (3Y5) 2014?2015 and 2015?2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compilant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipts).
The temporary exemptions are aiiowed for any type of grain produc'ds), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabte
products, and most comply with the SY 20134014 requirement of at least half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in aliowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014?2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, inctude in the other hardship section. List the grain prodacds) to be
exempted.

KantuckyUnoridtedSpirit.com Art Eqnat Opportunity Empioyer MIFIO

 

Yes

Hardship(s}:

List the type of grain produc?s}
to be exempted and attach
justification (pictures, receipts,
etc. for documentation]:

 

Financiei hardship: The records demonstrate a significant
drop in meal counts after the whoie grain-rich produc?s) was
offered.

Domino?s Pizza

 

Financiai hardship: The SFA experienced a significant cost
increase when procuring the whoie graimrich produc?s). 

 

Limited product The SFA does not have access to a
compliant whoie grain-rich productis) in the iocei market and
would like to offer enriched grain item_(s) temporariiy.

 

 

 

Unacceptable product quality: The whoie graiwrich productis}

offered by the SPA did not retain the desired texture or lost

during the typicai hoid?mg time.

 

 

Yes

Hardship(s):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich produc?s)
offered by the SPA received significant negative. student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich produc?s) was offered multiple times
and over a sostained period of time.

 

 

 

 

 

Other hardship {please list}:

 

 

List aiternative product typesibrands that have been 

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that ali records
to support the information are avaiiabie upon request by the State Agency, and that the SFAS receiving theexemption
must ensure that at least half of the grain items offered weekiy is whoie grain-rich.

wing/m

was Date

. . 3-1445



Approved Program Manager Date
*Please complete this form, sign, and electronically submit to Sue Bartenfieid at 

is an equal opportunity provider and empioyer.?

Page 3 of 3

Matthew G. Bevin
Governor

 

Stephen Pruitt, PM).
Commissioner of Education

Hal Heiner
Secretary
Education and

Workforce Development Cabinet

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower a 500 Mere Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-201S extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under the
terms they were approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain?rich product(s)
for the 201647 school year. This extension will be in effect for the 2016-17 school year and the SFA is
responsible for ensuring availability of whole grain rich products to meet the 100 percent of grains offered

must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as
well as other tried in the proper columns below.

 

Grain Product for
which an Extension of
Waiver is requested.

Continued Hardship (Financial
Hardship, Limited Product
Availability, Poor Student

Other Whole Grain

Products/Brands That Have
Been Tried and Were not

 

 

 

Acceptability, Other) Accepted
Cracker Poor Student Acceptability #114378
Biscuit Poor Student Acceptability #10077
Tortilla Poor Student Acceptability #13907

 

 

 

 

 

 

 

KenluckyUnbridledSpiril.com

  

 

UNHRIDLED 

An Equal Opportunity Employer 

My signature indicates that I understand and attest to the accuracy of the information provided above that all
records to support the info mation an?e available upon request by the State Agency, and that the exemption must
ensure the tlea 1/ half of he gr in ems offered weekly are whole grain rich

7 Wig/m

"Signature of Du egot'Schools? aw Date

 



 

m. 7:23 My;
Brogram Date

Please complete this form. sign, and electronicatty submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

 

Steven Beshear Terry Holliday, 
Governor Commissioner of Education

AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 500 Moro Street Frankfort, Kentucky 40601
Phone: (502) 564-4770 9 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, Sara Jane Hedges, as the duly authorized representative of McCracken County Public Schools, do hereby attest that the
aforementioned SFA and alt schools under its jurisdiction demonstrate a hardship in procuring compiiant whoie grair?e
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whoie grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agriculture to ailow State Agencies that administer the
National School Lunch Program and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in schooi years (3Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptabie to
students. 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipisl.
The temporary exemptions are allowed for any type of grain productls}, pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptabie
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekiy are whole
grain?rich products. 

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpirit.com An Opportunity Employer WFID

 
   

UNBRIDLED owl-err ..--

Yes

Hardshiplsj:

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation);

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

Whole Grain Biscuit

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productls}, El

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich productls) in the local market and
would like to offer enriched grain itemls) temporarily .

Whole Grain Zesta Crackers

 

 

 

 

Unacceptable product quality: The whole grain~rich product(s)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

Whole Grain Biscuit

Whole Grain Zesta Crackers

Whole Grain Tortilla

 

 

Yes

Hardshipls):

List the type of grain productls)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grainurich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich productls) was offered multiple times
and over a sustained period of time.

Whole Grain Biscuit

Whole Grain Zesta Crackers

Whole Grain Tortilla

 

 

 

Other hardship {please list):

 

 

List alternative product types/ brands that have been utilized:

 

 

 

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Cracker Sunshine Harvest Wheat General Mills #114378 CR8
Biscuit Biscuit Ralcorp/ Con Agra #10077 CR5
Tortilla Tortilla Mexican Original #1390? CR8


 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that ail records
to support the informatio are availableupon request by the State Agency, and that the SFAS receiving the exemption
must ensure that at le half of the grain items offered weekly is whole grain?rich.

4454/44) {Te/e 0% 425

Signature of Direetor {if/S} hools

?2/4644 aloud, [125?

Approved Program Manager Date

   

*Please complete this form, Sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital ?laza Tower - 500 Hero Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for lixemption for Whole Grain-Rich Requirements
School Year 2017-18

.- i
I, as the uly authorized representative of Name], do hereby attest
th the afore entioned SFA and all :chools under its jurisdiction demonstrate a hards ip in procuring, preparing, or

serving compliant whole grain-rich prod that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain ~rich products. In Section 747 of the Appropriations Act provides flexibilities related
to whole grains, sodium and flavored mi for school year (SY) 2017?18.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipts).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-20 [4 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2016 and SY 201 3?2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not list ed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Divisic of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the Echo il Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2015

2?
KentuckyUnbridledSpirilcom An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The re :ords demonstrate a signi?cant drop in
meal counts after the whole gra 1-rich product(s) was offered.

 

Financial hardship: The SFA rperienced a signi?cant cost increase

when procuring the whole grain- rich product(s). A

 

. I 
Limited product availability: The SFili does not have access to a w! WW- 
compliant whole gram-rich prouluctis) in the local market and would

like to offer enriched grain item( temporarily. 'Hrfa? KM
Preparation Hardship: Unacceitable product quality: The whole .- - 
grain-rich product(s) offered b' the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

List the type of grain productis) to
Hardship(5); :3:c:1::;npted (attach production

 



Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant neg: tive student/parent feedback or there
was increased plate waste of ti at menu item when the whole grain- I
rich product(s) was offered rnull ple times and over a sustained period
of time.

Other hardship (please list):

 

l? 1-. .

 

 

 

List alternative product types/brands th it have been utilized:

 

 

Grain Item Product Description Manufacturer Product Code

.H

in 6/ Cum 1M $1795

 

 

 

 

 

 

 

 

 

 

my Signature Indicates that I underst; nod and attest to the accuracy of the information provided above, that all
records to support the information ar 2 available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain i ems offered weekly are whole grain rich.

Mm 

Signatur? of Director of School Nutril on Program Date 

egg/av 

SCWWIC Program Ca??rdinator Date

Please complete this form, sign, and eleu tronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

(if i 5
any An Equal Opportunity Employer MIFID

UNERIDLED 5p;

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTU SKY DEPARTMENT OF EDUCATION

Capital laza Tower . 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 . 

Request for temption for Whole Grain-Rich Requirements
School Year 2017-18

l, as the d: ly authorized representative of MMLEM Name], do hereby attest
that the aforem ntioned SFA and all :hools under its jurisdiction demonstrate hard hip in procuring, preparing, or
serving compliant whole grain-rich prod: that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain- 'ich products. In Section 747 of the Appropriations Act provides flexibilities related
to whole grains, sodium and ?avored mil for school year (SY) 2017-18.

The State Agency may approve an exemption request for_specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed or any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted a exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-20: 4 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder of SY 2015-2016 and SY 201! -2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not list ad, include in the other hardship section. List the grain productls) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Divisior of School and Community Nutrition, KDE, under SP 33?2016, Exemption Notice:
Request for Exemptions from the Schot Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which :hey were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

i 
KentuckyUnbridledSpirit.com An Equal Opportunity Employer MJFID

UNBRIDLE SPIRIT

List the type of grain productis) to
be exempted and attach

Hardshipls): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The rec :rds demonstrate a signi?cant drop in
meal counts after the whole grair -rich productis) was offered.

 

Financial hardship: The SFA e) perienced a signi?cant cost increase
when procuring the whole grain-1 ich product(s). IE

Limited product availability: he SFA does not have access to a have WW Maw (k

compliant whole grain-rich prod in the local market and would 
like to offer enriched grain itemls temporarily. ?ii/d 2%me
a
337 0? were;

Preparation Hardship: Unacce; table product quality: The whole
textureorlost - 1

 

 



grain-rich product(s) offered by the SFA did not retain the desired

 

 

 

 

List the type of grain productis) to
be exempted (attach production

 

 

 

 

 

 

 

Hardshipis):
record):
Poor student acceptability: The Nhole grain-rich productis) offered by
the SFA received significant nega :ive student/parent feedback or there
was increased plate waste of th at menu item when the whole grain-
rich product(s) was offered mult ole times and over a sustained period
of time.
Other hardship (please list):
List alternative product types/brands th It have been utilized:
Grain Item Product Description Manufacturer Product Code

 

 



Mali: (Milk Wind 3695! (Sum) WC "1009My signature indicates that understa Id and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain itt ms offered weekly are whole grain rich.

a Will/2

of Direct of SchoolNutritinn Program D'ate 

42 
SC Program Co dinator Date

Please complete this form, sign, and elec ronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

  

 

d} 
K01 An Equal Opportunity Employer MIFID

KentuckyUnbridledSpirit.com "Nammp 5pm?-

Request for lixemption for Whole Grain?Rich Requirements
School Year 2016-2017

Milli Stephens the McCreary County School System
I, as the duly authorized representative of Name),

do hereby attest that the aforementio fled SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in'offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Linch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whole grain-rich :quirernent in the meal programs, in school years (SYs) 2014-2015, 2015?2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to studez ts.

 

The State Agency may approve an SEA ?5 exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowe for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardsh factors in allowing an exemption for the listed whole grain~rich product(s) for SY
2016?2017. Place an in the appro; riate column or columns (Yes) for each hardship consideration. If your hardship is

not listed, include in the other hardsh section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardshipls):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts aJter the whole grain-rich productls) was
offered.

 

 

 

Financial hardship: "he SFA experienced a significant cost
increase when procurin, the whole grain?rich productls).

 

 

 

Limited product avaiialiility: The SFA does not have access to a
compliant whole grain rich productls) in the local market and
would like to offer enric aed grain itemls) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain?rich product(s)
offered by the SFA din] not retain the desired texture or lost

 

 

Yes

palatability during the t" 'pical holding time.

Hardshipls):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student accepta )ility: The whole grain-rich product(s)
offered by the SPA rec eived significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multiple times
and over a sustained period of time.

WG Biscuits, WG Pasta

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Prods Ict Description Manufacturer

Product Code

 

Whole Gr :in Bread Product Pilsbury

4126.

 

Pasta Noodles Whole Grain Pasta Product Barilla

4087 4003

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and-attest to the accuracy of the information provided above, that all records
to support the information are availal ?le upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at feast half of the gr iin items offered weekly is whole grain-rich.

 

 

Mitzi Stephens, Food Service Di jector October 2016
Director of Schools I Date

0e3/~/ 
Program qufdinator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provide _r and employer.?

Page 3 of 3

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: McLean County Board of Education

Name of Product a waiver is being requested for:

130592 Pasta Azerega Smelt Spiral Rotini

Brand Name of product used:

130568 2~10 Lbs. Bariila WG Rotini

Recipe(s) in which the product is used:

Baked Ziti

Other products tested: Macaroni, spaghetti, penne noodles all have the same issue

Issues with products used and tested:

Product is sticky and turns to mush when cooked

internal Use Only

 

Date Submitted: 7 l??l

3-225:-

Date Approved: 

   

Approving Signature:
()st baht have) Swamps LU jvk-? c010,? 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individuai pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: McLean County Board of Education

Name of Product a waiver is being requested for:
130642 Patria Elbow Macaroni

Brand Name of product used:

130566 2*10 Lbs. WG Macaroni

Recipe(s) in which the product is used:

Macaroni Cheese

Other products tested: Rotini, spaghetti, and penne noodies all have the same issue

issues with products used and tested:

Product is sticky and turns to mush when cooked

Internal Use Only

 

Date Submitted: 7P9lp?M
Date Approved: 7 14

Approving Signature: ii ELLWW
6im?d0/r ?930?. ?in 513.54.th ?at WW

mom/vb mum -

 Prior Waiver Request for Whole Grain Rich Pasta 2014?2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: McLean County Board of Education

Name of Product a waiver is being requested for:

130642 20 lbs. Patria Spaghetti

Brand Name of product used:

130566 2-10 lbs. Barilla Pasta Whole Grain Spaghetti

Recipe(s) in which the product is used:

Spaghetti with meat sauce.

Other products tested: Macaroni, rotini, penne noodles all have the same issue

Issues with products used and tested:

Product is sticky and turns to mush when cooked

internal Use Only

 

Date Submitted:
Date Approved:

Approving Signature:

OW disln?ids lam sum wlSpong/Urd

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

i Te rry La caste Meade County Board of Education Food Service

as the duty authorized representative of Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whoie grain-rich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the Nationat School Lunch Program and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whoie grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to-search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for SY
2016-2017. Ptace an in the appropriate column or columns (Yes) for'each hardship consideration. If your hardship is

not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain itemls) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain?rich product(s)
offered by the SFA did not retain the desired texture or iost
paiatability during the typical holding time.

 

Biscuit

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s)

 

 

 

 

 

 

 

 

 

offered by the SFA received significant negative student/parent 
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.
Other hardship (please list):
List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
Biscuit Biscuit 2.51 oz Pillsbury 132267000
Biscuit Biscuit Bakery Chef 68615121031
Biscuit Biscuit 2.2 oz Peach Valley 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

Terry Lancaster 2/6/17

Director of Schools Date

 

emf?- W7

SCN7W?r6?r?arm Eoof??lnator Date
*Please con?iplete this form, Sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

- as the duly authorized representative of I (QM if?f do hereby attest

that the aforementioned and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products.

 

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 225 extends through school year 2013-19 the
menu ?exibilitles giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls} to be exempted.

List the type of grain productls) to
be exempted and attach
justification documentation

Hardship(s): (production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The EPA experienced a signi?cant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

Hardshipis):

 

Poor student acceptability: The whole grain-rich productis] offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productisi was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

- . . tomb
Ta?lku? Nico?Btdi? mii ii? ?mt 1 1 iraxLDCU :1 9\

"beget-e Me swam? Li'bici'lla?

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
record 0 support the information are available upon request by the State Agency. and that the exemption must
at at least half of the grain items offered weekly are whole grain ich.

pl
378?

ig?'ature of D?lrector of School Nut?ljnn Program 
Date

 
 
 
  

ate

     

Coordinator

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort, Kentucky 40601
Phone: (502) 554-5625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, as the duly authorized representative of C0. Name], do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

 

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns [Yes] for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain prod to be exempted.

[(011th t?
KentuckyUnbridledSpirit.oom ?Mama,? sermry An Equal Opportunity Employer MIFID

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.



Sighatur? df D?irebtoljaf School Nutrition Program

Am
SCNIMC P'rogr??m Coordinatoa/

Date

40/

Date

5l501 8

77?

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justification documentation
[production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

Bra-cut 
A 

 

 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justification (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls} offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.


Ari Pas-i 

 

KentuckyUnbrid

 

Other hardship (please list):


Karat/ft

edSpirit.com

An Equal Opportunity Employer 

 

 

 

 

 

Matthew Bevin Stephen Pruitt, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capltal Plaza Tower 0 500 Mero Street . Frankfort, Kentucky 40501
Phone: (502) 564-4770 . 

Request for Exemption for Low-Fat Flavored Milk
For School Year 2017-18

Sandy Ramsey mammam.

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(c) of the Appropriations Act, through SY 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk
fat) ?avored milk through the NSLP and the SBP 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.

Documentation Submitted
(invoices, waste study,

Yes Hardshipls): production records, etc.)

Signi?cant decrease in milk sales since implementation of the
- current meal pattern. Mme-nun 

 

 

Declining milk sales despite offering alternative products and
brands.

 

A food waste study indicating signi?cant waste of fluid milk.

 

Significant negative feedback from students and parents
regarding lack of availability of low-fat, flavored milk

 

Signi?cant negative feedback from students regarding the
palatability of fat-free, flavored milk.

 

 

 

 

 

KentuckyUnbridledSpini com An Equal Opportunity Employer WHO
I. (anemones?smorry

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information ar available upon request by the State Agency.

 

 

July 13, 2017

utrition Pro'gram Date

pproved Program Manager/am Date 71779-77

*Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.Wagner@education.ky.gov

ignature of Director of 5:110

     
 

is an equal opportunity provider and employer.?

Page 2 of 2

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2015?17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich
product(s) for the 2016?17 school year. This extension will be in effect for the 2016-2017 school ear and
the SPA is res onsible for ensurin availabili of whole rain rich roducts to meet the 100 ercent of
gains offered must be whole qrain rich requirement for the 2017-18 school year.

  

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other products/brands tried in the proper columns below.

 

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain
which an Extension of Hardship. Limited Product Products/Brands That Have
Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability. Other) Accepted
Poor Student Acceptability 10" Not available thru my
Flour Tortilla 10" vendor. (only 12" WG)
gnaw mm, 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption
must ensure that at least half of the grain items offered weekly are whole grain rich.

 

 

 

 

i XMLD Middlesboro ISD - al 7
Signature of Director of St?nools District Date
a- a? ?322) 
Program ?ardinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.kygov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capitai Plaza Tower a 500 Mero Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016-2017

1, Debbie Mayes, SFSD as the duly authorized representative of The Middlesboro Board of Education,
Middlesboro School Foodservice, do hereby attest that the fore mentioned SFA and all schools under its jurisdiction
demonstrate a hardship in procuring compliant whole grain-rich products that are acceptable to students, and that the
factors indicated in this document pose a challenge in offering whote grain-rich products. in Section 751 of the Consolidated
and Further Continuing Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to
allow State Agencies that administer the National School Lunch Program (NSLP) and School Breakfast Program to
grant an exemption from the regulatory whole grain?rich requirement in the meal programs, in school years (SYs) 2014'
2015, 2015-2016 and 2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant
whoie grain-rich products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemptionmust work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain~rich
products. 

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the

remainder of SY 2015-2016 and SY 2016?2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

*Reference: SP 33-2016

     

KentuckyUnbridledSpirit.com umcw?sm? An Equal Opportunity Employer were



List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich producds) was offered.

in order to increase more grain, we
offer WG crackers whenever having
salads, soups, and chili.

 

Financial hardship: The SEA experienced a significant cost increase
when procuring the whole grain?rich product(s). it]

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and wouid
like to offer enriched grain item(s) temporarily.

 

Unacceptabie product quality: The whole grain?rich product(s) offered
by the SFA did not retain the desired texture or iost during
the typical holding time.

 

 

The WG cracker are very pasty. With a
terrible after taste.

 

Hardship(s): Yes

List the type of grain produc?s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain?rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item?when the whole grain-
rich product(s) was offered muitiple times and over a sustained period
of time.

Most student do want the crackers.

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

Crackers/Saltines

Grain Item Product Description Manufacturer Product Code
WG 4pk WG Crackers/Saltines Keebler 48405
Crackers/Saltines
WG 4pk WG Crackers/Saltines Heritage Ovens 271131

 

 

 

 

 

 

 

 

 

My Signature Indicates that understand and attest to the accuracy or the Intormatton provroed above, that at!
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

.2345

Signature of Director of Sqfuools Date

6a? :2 

?ro?gram Cog?f?ator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

  

An Equal Opportunity Employer MIFID

 



Request for an Extension ofWhole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary fiexibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors In allowing an extension for the listed whole grain rich
product(s) for the 2016 17 school year This extension will be In effect for the 2016-- 17 school year and
the SFA is responsible for ensuring availability of whole grain rich products to meet the 100 percent of
grains offered must be whole grain rich requirement for the 2017?18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other productsibrands tried In the proper columns below.

 

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain
which an Extension of Hardship, Limited Product Products/Brands That Have
Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability, Other) Accepted
Pillsbury WG Poor Student Acceptability i have tried several brands
Southern Style and students will not take.
Biscuits Do not hold well in warming
cabinet.
WG Pastas Poor Student Acceptability WG pastas do not cook up
well and breakdown during
holding.

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure that at least half of the grain items offered weekly are whole grain rich.

[Wm M04) Middlesboro ISD K7 ?3x512 (n

Signature of Director of So?aols District Date

 

Program CWinator Date

Please complete this form, sign, and eiectronicaiiy submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

Steven L. Beehear Terry Holliday, PM).
Governor Contrt?lissionor of Education

EDUCATION AND DEVELOPMENT CABINET
DEPARTMENT OF EQUCATIQN

Capital Plaza Tower 0 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 534?4?70 ameducatiomkmgov

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015-2016

i, Debbie Mayes. as the duly authorized representative of Middlesboro independent School District, do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain~rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 20134014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s} for
the remainder of SY 2014-2015 and 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

KentuckyUnbridledSpirit.com

  

I An Equal Opportunity Employer ill/FIB
ii;

UNEHIDL ED 

    

Yes



List the type of grain prod uctm. .
to be exempted and attach
justification (pictures, receipts,
etc. for documentation}:

 

YES

Financial hardship: The records demonstrate a signi?cant

drop in meal counts after the whole grain-rich productls) was

offered.

Breakfast numbers have dropped
signi?cantly. Piease see attached
sheet.

 

YES

Financiai hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich product(s). a

Most whole grain products are
more expensive than regular.

 

YES

Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the local market and
would like to offer enriched grain itemls) temporarily.

Checked with other vendors and
local grocery stores

 

YES

 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SPA did not retain the desired texture or lost
paiatability during the typical holding time.

The whoie grain products are dark and not what the students are
used to seeing. Therefore if it?s different, they automatically

 

 

Yes

Ha rdship(sl:

List the type of grain produc?s)
to be exempted (attach
production record):

 

Poor student The whole grain-rich productls)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich prodocds) was offered muitiple times
and over a sustained period of time.

Students are compiaining about the
crust being dry and hard.

it is does not hold well in a warming
cabinet.

 

 

 

Other hardship (please list):

 

 

Page 2 of a

 

 

 

Steven L. Beshear Terry Holiiday, PM).
Governor Commissioner of Education

EDUCATION AND DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 More Street Frankfort, Kentucky 40801
Phone: (502) 564-4770 . wereceducatiomkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2015

1, Debbie Mayes, as the duiy authorized representative of Middlesboro tndependent School District, do hereby attest
that the aforementioned SFA and alt schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain-?rich products that are acceptabie to students, and that the factors indicated in this document pose a chaiienge in
offering whole grain?rich products. in Section 753. of the Consolidated and Further Continuing Appropriations Act, 2015
{Pubiic Law 113~235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemptioe from the regolatory
whole grain?rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015?2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to

students.

The State Agency may approve an exemption request for Specific products if the SFA can demonstrate hardship(s}.
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013~2014 requirement of at feast half of the grains offered ereelrl'yr are whole-

grain-rich products.

The State Agency witl consider hardship factors in allowing an exemption for the listed whoie grain?rich productls) tor
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns {Yes} for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be

exempted.

KeoiuckyUnhridledSpiritcom A An Equal Opportunity Employer WHO

  
   

SPIRIT -

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

 

Yes Hardshipis):
etc. for documentation):

YES Financial hardship: The records demonstrate a significant Breakfast numbers dropped
drop in meal counts after the whole grairvrich productls} was significantly. 'Pieese see
offered. attachment.

YES Financial hardship: The SFA experienced a significant cost Most whole grain products are
increase when procuring the whole grain?rich productis). more expensive.

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls} in the local market and
would like to offer enriched grain itemls) temporarily.

YES Unacceptable product quality: The whole grain?rich productls) The whole grain products are dark,
offered by the SFA did not retain the desired texture or lost and not what the students are used
paiatability during the typical holding time. to seeing. Therefore if it?s

different, they adtomaticaiiy don?t
want to eat it. especiaiiv at the high
school level.
Even the Papa John?s School Pizza
with whole grain crust only lasted a
few months. The students get to
the point they didn?t like that wg
crust and we had to change back to
other options.
List the type of grain productls)
Yes Hardship(si: to be exempted (attach
production record}:
YES Poor student acceptability: The whole grain-rich product(s} Whole Grain Biscuits

offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich produc?s) was offered multiple times
and over a sustained period of time.

Any Pizza with Whole Grain Crust

Whole Grain Pasta

 

 

 

Other hardship (please list):

Whole Grain Pasta is the worst. The pasta does not hold up,
example in soup, the pasta would dissolve and the soup would
become very thick and pastey.

 

 

 

List alternative product types/brands that have been utilized: We have tried many different products, even went as

far as to buy products from Kroger and Walmart, to compare with the whole grain products from the vendors.

Page 2 of 4

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuits 216/2202 Southern Style Pillsbury 2173090
220/2202 Mary B?s 8705190
Pizza
WG Pasta Barilla W6 10# Barilla 2314343

 

 

 

 

 

 

?We had to use rotini in soups etc it was the only thing that wouldn?t dissolve.?

My signature indicates that understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAS receiving the exemption
must eni? at at least half of the grain items offered weekly is whole grain-rich.

  

 

Sig -- Date
@ba?mpm 0411,11,) "7??ng 
Approved Program Manage-*3 Date

*Please complete this form, Sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 4

 

List aiternative product types/brands that have been 

 

 

Grain Item Product Description Manufacturer Product Code
we Pizza Crust Whole Pepperoni Pizza, Tony?s Pizza
WG Cheese Pizza

 

WGSausage Pizza 
WG Breakfast Pizza

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that ail records
to support the information are avaifabie upon request by the State Agency, and that the SPAS receiving the exemption
must at at least half of the grairgjtems offered weekly is whole grain?rich.

'2 gee/~15?

Signature of Director of Schoois Date

(QQMULW M) Alp 
A V1 
pprove rogramt anaggr . .. romceiiy submit to Sue art re at 

  
 
 
   

     

Page 3 of 4

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018?19

I, jo??n as the duly authorized representative of 1 Lo Aron. Co . Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

List the type of grain product(s) to
be exempted and attach
justification documentation

Hardship(s): (production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

Hardship(s):

 

Poor student acceptability: The whole grain-rich product(s) offered by
. the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
u?fir? H- 
\gb 3Lg\_l :L3&5331

 

 

 

My Signature Indicates that I understand and attest to the accuracy 01' the Intormatlon provrdecl above, that all

 

[a ?7 ~67

Sign t?ure of Director of School Nutrition Program Date

 

H?ldfg?

Program Coordinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mere Street . Frankfort, Kentucky 40501
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Ljulle lad?Ca?; as the duly authorized representative of mom?m"! CD (Sg?galv?m?, do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related
to whole grains, sodium and ?avored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

i 
KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain productls) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). Ii]

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich productts) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Dalia]? (Minus
SPaShc/i)

 

Hardship(s):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Puma Pasta

fully Cooked Penna Rama (Tutsi?)

TM) a Hacked?, males"

 

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy ot the Intormatlon provrded above, that at!
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Gum? Wit/1W rl Ila/I7

. Signature 0 'irector of School Nutrition Program Date 

[41 f? 1"ng 7

SCN Program UWnator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

(mi: 5 
KentuckyUnb?dledSpirtt.com ?my An Equal Opportunity Employer MIFID

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

hm WM . as the duly authorized representative of WW ?01104 Mme],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a Hardship in procuring
compliant whole grain- -rich products that are acceptable to students and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain?rich requirement in the meal programs, in school years (5Y5) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

EICID

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost

 

palata bility during the typical holding time.

 

Pawn Valley: Wm?
B?mq?

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

 

 

Other hardship (please list):

 

 

 

List alternative product types] brands that have been utilized:

 

9

Grain Item Product Description Manufacturer

Product Code

 

 

 

3(15/

 

. . .
jump} . lTW'Bjwamgt WM

 

 

 

 

 

 

 

 

Page 2 of 3

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.



 

 

Directorfof S?Ehools Date
ref/i vii/?r;
Program Coordih?'or Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at sandramagnerQeducatlan.ky.gov.

is an equal opportunity provider and employer."

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, PILD.
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mare Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 . educationkygov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

  

l, - as the duly authorized representative MW Name], do hereby attest
that aforem itioned SFA and all schools under its jurisdiction demons rate a hards ip in procuring compliant whole
grain rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act. 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory whole grain-
rich requirement in the meal programs, in school years (5Y5) 2014~2015, 2015-2016 and 2016-2017 to a school food
authority that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Age'ncy may approve an exemption request for speci?c products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich

products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015 2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain prod uct(s) to be exempted.

*Reference: SP 33-2016

1? d? i?
KentuckyUnbridledSpirit.com Ken An EqualOpporlunity Employer 

UNERJDLED SPIRIT

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

_Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

when procuring the whole grain- -rich Iproductls) 12]

d, 

Limited product availabil?itv: The SFA ?does not have access to a
compliant whole grain- -rich product(sl in the local market and would
_like to offe_r_ enriched grain ilem(_s) temporarily.

rFinanclal hardship: The SFA experienced a significant cost increase i

 

Un?acceptable product quality: Ihe whole grain- rich product(s) offered
by the SFA did not retain the desired texture or lost palatability during
tl?typical holding?me. 

 

 

c.

hank "r at?! ails-ft.

 

 



.Poozstodent acceptabilitij: The whole grainarich productl-s) offered by 1?

the SPA received significant negative student/parent feedback or there

was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple tImes and over a sustained period
o_f time.

Other hardship (please list):

marinade a. 1.0+ 
JI'lrLe Kids -H\roca Caddy.

 

is: rim.?


List the type of grain product(s) to
be exempted (attach production
record):

Biseoilcs ?ll (Dish

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
90 whol?jrg; 1426:"ch a; 15064 8/
3; 5:!an me some 0194th .. mill/lam #3151
535 LU Co Ei?sc?? [gas]; \l?lncl? 1'05 35

 

we Nachied <20qu biscuit-m 00+ +hgr?

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

454 

Director ofSchools

Date

4% mew/Z

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

 

is an equal opportunity provider and employer."

Page 3 of 3

Request for Exemption for Whole Grain?Rich Requirements
School Year 2018-19

I, April Adams, as the duty authorized representative of Murray Independent Schools, do hereby attest that the
aforementioned EPA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-201743021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the Option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipts).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Hardship(s]:

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

Crackers Saltine

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemis) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardshipls):

 

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, student?s ietters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation [production records,
meal counts, student?s letters,
surveys, etc):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Biscuit

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

Hardshipis):

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significa nt drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(sl in the local market and would
like to offer enriched grain item(s) temporarily.

Fiesta Rice - This is the only
Mexican rice that is currently on
bid to offer with Mexican meals

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation {production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

My slgnature Indicates that I understand and attest to the accuracy ot the information prowoed above, that all
records to SUpport the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

5 ??316

 

 

 

 

Signature of Director of School Nutrition Program Date'
24/60 6U 7?7f7?p
Program Coordina?i?r Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

Steven L. Beshear I Terry Hoiliday, 
Governor - . Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Ptaza Tower - 500 Mere Street 0 Frankfort, Kentucky 40801
Phone: (502) 584-4?70 . 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, April Adams, as the duly authorized representative of Murray independent Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain?rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015?2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s}.
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rlce, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014?2015 and 2015?2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

KentuckyUnhridledSpirit.com

UNBHIDLED SPIRIT . 

   

Yes

Hardship(s):

List the type of grain produc?s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The EPA experienced awn-significant cost
increase when procuring the whole grain?rich product(s). 

 

Limited product availability: The SFA does not have access to a

compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

Croutons

 

 

 

 

Unacceptable product quality: The whole grain-riCh produc?s)
offered by' the SFA did not retain the desired texture or lost
palatabiilty during the typical holding time.

 

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain?rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list}:

 

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that ail records
to support the information are availabie upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least haif of the grain items offered weekly is whole grain-rich.

(L?nk 0 115??: Yea 

Signature of Director of Schools

Approved Program Manager

        

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Steyen L. Beshear Terry 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-4770 ww.education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, April Adams, as the duly authorized representative of Murray independent Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whoie grain-rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015?2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 5r 2013-2014 requirement of at least half of the grains offered weekly are whole
grain~rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate coiumn or coiumns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be
exempted.

KentuckyUnbridledSpirit.com An Equal Opportunity Empioyer MIFID

 
   

- UNBRIDLED SPIRIT

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich product(s) was
offered.

 

Financial hardship: The SFA experienced 3 ?Significant cost
increase when procuring the whole grain-rich producds). -

Crackers Saitine

 

Limited product availability: The SFA does not have access to a 

compliant whole grain-rich product(s) in the locai market and
would like to offer enriched grain itemis) temporarily.

 

 

 

 

Unacceptable product quality: The whole grain~rich product(s)
offered by the SPA did not retain the desired texture or lost
palatability during the typicai holding time.

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain?rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich producds) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

 

 

Page 2 of 3

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

(1) Pl mx F33

Signatjre of Director ofSchoois

Apptoved Program Manager

 

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equai opportunity provider and employer.?

Page 3 of 3

 

Steven L. Beshear Terry Holiiday, Phi}.
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION -

Capital Plaza Tower 9 500 Mere Street 9 Frankfort, Kentucky 40601
Phone: (502) 5644??!) 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

l, April Adams, as the duly authorized representative of Murray independent Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whoie grain?
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113435), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and Schooi Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain~rich requirement in the meal programs, in school years (5Y3) 2014?2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain~rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whoie
grain-rich products.

The State Agency wiil consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014?2015 and SY 20152016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, inciude in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

 
 

 
 

MNBIDLED 5 our ..

YES

 

Hardship(s):

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s). -

 

Limited product availability: The SFA does not have access to a
compliant whoie grain-rich product(s] in the local market and
would like to offer enriched grain item(s) temporarily.

Fiesta Rice - this is the only type of
Mexican rice that offer students with
Mexican type meals.

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or iost
palatability during the typical holding time.

 

 

Yes

Hardshipls):

List the type of grain productls)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SPA received significant negative student/parent
feedback or there was increased piate waste of that menu item
when the whole grain~rich productls) was offered rnuitipie times
and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

(193$! (x tax-Mrs} E)

 

 

Signat?ure of Director of Schools Date
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Valerie Crouch at 

is an equal opportunity provider and employer.?

Page 3 of 3

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

. . Eaton County
I. ?5685 Ca ell ES as the duly authorized representative of' Dl Di. Name], do hereby attest that

the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls). The
temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. Ifyour hardship
is not listed, include in the other hardship section. List the grain product(s) to be exempted.

This institution is an equal opportunity provider.

Hardship(s):

List the type of grain product(s) to
be exempted and attach justification
documentation (production records,
receipts, photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would like
to offer enriched grain item(s) tern porarilv.

 

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich product(s) offered by the SFA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach justification
(production records, meal counts,
student?s letters, surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
productts) was offered multiple times and over a sustained period of
time.

(?71 bisw/H
81 903m

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
8i?suM'l' QFS If} 
Pasta ems 415310 I 8.32 L, I 10

 

 

 

 

 

 

This institution is an equal opportunity provider.

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?muted/9AM ?3448

Sigh u?Fe of Director o?L?Mn?ol Nutrition Program Date

37 

F??gfram Coordinator Date 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

This institution is an equal opportunity provider.

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bean
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mere Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, ?1111; Eider as the duly authorized representative of Nithll??l a. Name], do hereby attest
that th aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich for the 2017/18
school yea r. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productts) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under 5P 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

?Reference: SP 32-2017
SP 33-2016

KBHIUWUnb?dledSpi?me An Equal Opportunity Employer 

List the type of grain productis) to
be exempted and attach

Hardshipts): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productts] was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The EPA does not have access to a
compliant whole grain-rich productis) in the local market and would
like to offer enriched grain item(s] temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardshipls): recordl'

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there 
was increased plate waste of that menu item when the whole grain-
rich product[s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

5 ii bi 8 qunm [it 8 [ch I4 Pf ?556117 [0 ?2'3?50

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all

record to suppowmn are available upon request by the State Agency.
20/2/15?

Signattlr of Dil?ectorf of?chool Nutrition Program Dal 

I 
SCN Prog mCoordi or Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

KentuckyUnbridledSpint.com An Equal Opportunity Employer MIFID
SPIRIT 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I Dianna Wilson Ohio County Board or Education

as the duly authorized representative of Name],
do hereby attest that the aforementioned SFA and schoois under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consoiidated and Further Continuing
Appropriations Act, 2015 (Pubiic Law 113-235}, Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardshipin procuring compliant whole grain?rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are ailoWed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the SY 2013-2014 requirement of at ieast half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whoie grain?rich product(s) for SY
2016-2017. Place an in the appropriate coiumn or columns (Yes) for each hardship consideration. If your hardship is

not listed, include in the other hardship section. List the grain productis) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain?rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

Spaghetti, Macaroni,(all
Pasta) Crackers, Biscuits

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekty is whole grain?rich.

Dianna Wilson 7/22/16

 

 

Director of Schools Date
??14 62$ 42M 
Program Coordy?t?or Date

I *Please complete this form, sign, and electronically submit to Sandy Wagner at 

 

is an equal opportunity provider and emptoyer.?

Page 3 of 3

 

Steven L. Beshear Terry Hoiliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE 
DEPARTMENT OF EDUCATION

Capital Plaza Tower 9 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502) 564-4770 . 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015?2016

l, Dianna Wilson. as the duly authorized representative of Ohio County Schoois Food Service Director Name], do
hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing

Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies,

that administer the National School Lunch Program and School Breakfast Program (SBP) to grant an exemption
from the reguiatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015-2016,
to a school food authority (SFA) that demonstrates a hardship in procuring compliant whoie grain-rich products that are
acceptable to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls}, pasta, bread, brown rice, etc.) and for one
or more different prodUcts. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products. 

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product(s) for
the remainder of SY 2014?2015 and SY 20154016. Place an in the appropriate coiumn or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain producds} to be
exempted.

KentuckyUnbridledSpirii.com An Equal Opportunity Employer MIFID

 
 

 
 

~W~eroczo 

 

 

. .. . .

 

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

Dough Biscuit 51% W6 RAIN

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost

during the typical holding time.

 

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich product(s) was offered multiple times
and over a sustained period of time.

Students do not like the WGRAIN
biscuit

 

Other hardship (please iist):

 

The WGrain Biscuits is more costly

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

Biscuit

Biscuits General Mills

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

ct6r 
Appr?E/d/?iogram Manager

*Please complete this form, Sign, and electronically submit to Sue Bartenfielcl at 

   

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

 

 

 

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

Hat Heiner
Secretary
Education and

Workforce Development Cabinet

KENTUGKY DEPARTMENT OF EQUGATIGN

Capital Plaza Tower 500 More Street Frankfort, Kentucky 40601
Phone: (502) 584-3141 0 

Request for an Extension cf Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under the
terms they were approved, through school year 2016?17, at the discretion of the State agency.

The State agency wiil consider hardship factors in allowing an extension for the listed whole grain-rich product(s)
for the 2016-1 7 school year. This extension will be in effect for the 2016?17 school year and the SFA is
responsible for ensuring availability of whole grain rich products to meet the 100 percent of grains offered
must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as
welt as other products/brands tried in the proper columns below.

 

Grain Product for
which an Extension of
Waiver is requested.

Continued Hardship (Financial
Hardship, Limited Product
Availability, Poor Student
Acceptability, Other)

Other Whole Grain

Products/Brands That Have
Been Tried and Were not

Accepted

 

Poor student acceptability

 

 

Pasta Spaghetti
Poor Student acceptability
Macaroni I .
Poor Student acceptability and
Biscuits WG more costly

 

Wheat crackers

Poor student 

 

 

 

 

 

 

KentuckyUnbridiedSpirit.com

    

UNBRIDLED SPIRIT

An Equai Opportunity Empioyer MIFID

My signature indicates that i understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Wm I Waite/?;

Si?nature of Dire?ctor of'Schools Date



Program [Coordinator Date

Please compiete this form, sign, and eteotronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2815

instructions: submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 - 2015.

Sponsor Name:

(9 in COLLNS SQMEKS

Name of Product a waiver is being requested for:

ELUOOLD ARC/Lamina: 6H5 qurem

Brand Name of product used:

(700%me mm Cu.

Recipeis) in which the product is used:
Name owl theme

Other products tested:

NWVL groan diced, ymgamom.

issues with products used and tested:

x?v Chime

3?ch ?Va Mum
Meat do mbf\ ?Ce ?bk; .

internai Use Univ

 

Date Submitted: 7" 
Date Approved: 7 )1 
Approving Signaturevj?m 

0% citSMc/?i? WIPE (?air: ESSuew: 04360401? how Uta/Q
?wx Ciao/?19 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Iran-sine Vom as the duly authorized representative of Old hem Costly Name], do hereby attest that
the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The Interim final rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the menu
flexibillties giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls]. The
temporary exemptions are allowed for any type of grain prod uct(s), pasta, bread, brown rice, etc.) and for one or more
different products. SFAs granted an exemption must work with the State Agency to search for acceptable products, and must
comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the

2013-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. Ifyour hardship
is not listed, include in the other hardship section. List the grain productis) to be exempted.

This Institution is an equal opportunity provider.

Hardship(s):

List the type of grain productls) to
be exempted and attach Justification
documentation (production records,
receipts, photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop 
meal counts after the whole grain-rich productls] was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and would like
to offer enriched grain itemls) temporarily.

There is no whole. om
Uri-"Sic? @rudyat. Qw??qblt

l-o we cur cinn-

 

 

Preparation Hardship: Unacceptable product quality: The whole grain-
rich product(s) offered by the SPA did not retain the desired texture or
lost palatability during the typical holding time.

 

 

 



List the type of grain product(s) to
be exempted and attach justification
(production records, meal counts,
student's letters, surveys, etc.]:

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-rich
productls) was offered multiple times and over a sustained period of
time.

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

This institution is an equal opportunity provider.

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered week!y are whole grain rich.

 
 

92/ 

to? of Schooi??utrition Program Dat?

[zap?sly 9?7?

ngfdinator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

This institution is an equal opportunity provider.

 

Request for Exemption for Whole Grain?Rich Requirements
School Year 2018-19

i, Savanna. vane-mama as the duly authorized representative of toontg? Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s} to be exempted.

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

Minnie Cumin Biscuit-

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

Lu pie Camfn Elmir-

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justification (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

9?9- Ell-semi-

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
121::le $3.1st wt; 33an 
Ev?j
?ZtoCi'ZlD gwsm?- Dm??b, Sam, w?a General Mills Ztoq "140

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy ot the Intormatlon provrded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

5/24??

Signature of Director of? School Nutrition Program Date

5939/?
SC MC Program Coordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandrawagner@educatlon.ky.gov

 

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower I 500 Mero Street . Frankfort. Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, W, as the duly authorized representative of Name], do hereby attest
that the foreme ioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing. or

serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KmmE?kk?g

KenluckyUnbridiedSpintcom urvamoceo ?my An Equal Opportunity Employer 

List the type of grain productis) to
be exempted and attach

Hardshipis): Justification (pictures, receipts.
etc. for documentation]:

 

 

'5 Financial' hardshi-pzh?eE?srecords demonstrate a signi?cant drop in
. meal counts after the whole grain-rich productls) was offered.

 

 

 

Financial hardship: The SFA experienaed? a signi?cant comncrease
when procuring the whole grain-rich 1'

Limited product atrial-"ability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain ltemls] temporarily. .
Preparation Hardship: Unacceptable product quality: The whole'

grain-rich productls) offered by the SPA did not retain the desired
texture orlostpalatahility . wing] .

 

List the type of grain product(s) to
Hardship{s): (attach production

 

. .. 

 

I Poor student acceptability: The whole grain-rich productis) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-

rich productis} was offered multiple times and over a sustained period
oftime. Q) 

 

Other hardship (please list):

Dilienplcol and rein/(maimed mang him: cinema

mm is smegma
not accepting oH?ius opium 50 MCth? aiuclosave Uniic rice.

 

List alternative product typesibrands that have been utilized:

 

 

4.. 

Grain Item Product Description Manufacturer Product Code



 

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy ol the tntormatlon prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Signaturso; DireZtgr 0: School Nutrition Program Date



Program Co?fdinator Dale

 

 

Please complete this form, sign. and electronically submit to Sandy Wagner at 



com unramoceo An Equal Opponunlty Employer 

Hal Hefner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street 0 Frankfort, Kentucky 40501
Phone: (502) 564-3141 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, as the duly authorized representative ofW?h?i?SFA Name], do hereby attest
that the rementloned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or

serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year 2017-18.

may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they Were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016


enIude a t?
KentuckyUnbridledSpirit.com uueerocso 5pm?. An Equal Opportunity Employer 

List the type of grain productis) to
be exempted and attach

Hardshipis): Justi?cation (pictures, receipts,
etc. for documentation):

 

 

Financial hardship: ?l'he SFA's records demonstrate {signi?cant drop in II ?1
meal counts after the whole grain-rich productis) was offered,

 

Financial. hard?ship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis). 

 

Limited product availability: The SFA does not have access to a 
compliant whole grain-rich product(s) in the local market and would 5
i like to offer enriched grain itemis] temporarily. 
rPreparation Hardship: Unacceptable product quality: The whole 

I grain-rich productisi offered by the SPA did not retain the desired
. texture or lost palata bility dp_rin__g_the typical holding time.

 



 

 

- 

 

 

List the type of grain productis) to
be exempted (attach production

record):

 

 

Poor student acceptability: The whole grain-rich productis) offered by Cl. mm
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

Mug 9' Mal (bang and Medusa! 
Beasic r2 0? (1)2951 myserwdm pm save/2:196:15. Him!

benefil,bom Ana/26ml! and Sex/W and
imagine; .p?sasa gala FWW- 

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
rec ds to port the information are available upon request by the State Agency.

1/ 54148

Dire of School Nutrition Program Date

5?77?

SCNTIWC Program Coordi or Date

  
 
  

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra 


mtudz 
KentuckyUnbridledSpirit.corn UNBRIDLED An Equal Opportunity Employer 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, as the duly authorized representative of Name], do hereby attest
that aforementioned SFA and all schools under its jurisdiction demonstrate a ha ship in procuring, preparing, or

serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products if the SFA can demonstrate hardshipis). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

SCNIKDE will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32-2017
5P 33-2016

mars-s

KentuckyUnbridledSpiritcom unremoceo Emmy An Equal Opportunity Employer 

Hardship(s):

List the pe of grain produc?s) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain productts) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grainu
rich product(s) was offered multiple times and over a sustained period
of time.

?hole (ham ?iscuji-

 

 

Other hardship (please list):

 

Wampum

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

Grams-J I 53?!

 

3.1mm} Sammie P, llsburg

 

 

 

 

 

 

 

 

 

My signature Indicates that i understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency.



SIgna re ofD or of School Nutrition Program Date

?3 4 ~54
30 Program or Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 


eniude 
An Equal Opportunity Employer MIFID

KentuckyUnbridledSpirit com sprm?r

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016-2017

   

as the duly authorized representative of .. Name},
do here attest hat the aforementioned SFA and all schools under its jurisdiction demons 'ate a hardship' In procuring
compliant whole grain? ?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. tn Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the Nationai School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate 
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013?2014 requirement of at least half of the grains offered weekly are whole
grainurich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whoie grain-rich product(s) for SY
2016?2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is

not listed, inciude in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33~2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meai counts after the whole grain?rich productls) was
offered.

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain?rich productis).

U6 Qgiscuit

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain?rich productls)
offered by the SFA did not retain the desired texture or test
palatability during the typical holding time.

 

 

Yes I

Hardship(s):

List the type of grain productls)
to be exempted (attach 
production record):

 

Poor student acceptability: The whole grain?rich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

LOG gleam i-

 

 

 

Other hardship (please list):

The, uhaic grain adapr?dluct is not
sound daihe nmupim

5mm prorated in cares.

 

(dig/UM?

 

List alternative product types/brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

cg Q251- 

6i??ischw?di? I Date

   

 

 

  

 

4 (a 
Program Coog??ior Date 

*Please complete this form, sign, and electronically submit to Sandy Wagner?at 

is an equal opportunity provider and employer.?

Page 3 of 3

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary ?exibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-

17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productls) for the
2016-17 school year. This extension will be in effect for the 2016-17 school year and the SFA is responsible for ensuring
availability of whole_gr_ain rich products to meet the 100 percent of wins offered must be whole grain rich reguirernent
for the 2017-18 school yea r.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain Products/Brands That Have Been
which an Extension of Hardship, Limited Product Availability, Tried and Were not Accepted
Waiver is requested. Poor Student Acceptability, Other)

Poor Student Acceptability, Limited Westminster WG Cracker, Sunshine Harvest

 

 

 

zesm cracker Product Availability Wheat Cracker
Poor Student Acceptability, Limited WG Rolled Taco - Egg, Sausage, Cheese. and
Breakfast Tornado Product Availability Potato. Schwans Breakfast Sliders
. . Poor Student Acceptabllity Otis Spunkmeyer Choc Chip Cookie, Otis WG
Ch'p C??k'e Carnival Cookie, Kellogg's WG Rice Krispie Treat

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least

half of the ?&m5 (WM weekly are whole grain rich.

 

 

6(61201 6
Signature of Director of Schoolsm?a Date
ME 
Program Coord?tor Date

I"Please complete this form, sign, and electronically submit to Sandy Wagner at sa ndra.wagner@education.lg.gov.

is an equal opportunity provider and employer.?

Page 1 of1

 

Steven L. Beehear Terry Hotiiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
EDUCATION

Capitat Plaza Tower a 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 584-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, Lisa McCarty . as the duly authorized representative of Owenshoro 1nd Schools Name], do hereby attest
that the aforementioned SFA and all schoois under its jurisdictiOn demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a chatlenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Conttnuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School tunch ?rogram (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regoiatory
whole grain-rich requirement in the meai programs, in schoo! years (3Y3) 2014?2015 and 2015?2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekiy are whole
grain?rich products.

The State Agency will consider hardship factors in ailowing an exemption for the listed whole grain?rich product(s) for

the remainder-of SY 2014-2015 and SY 2015-2016. Place an in the appropriate cotumn or cotumns (Yes) for each

hardship consideration. If your hardship is not tisted, include in the other hardship section. List the grain productis) to be
exempted. -

KentuckyUnbridiedSpirlt.com An Equal Opportunity Employer MIFID

 
   

UN ERIDL 7' 

 

Yes

Ha?rdshipls):

List the type of grain productls')
to be exempted and attach
justification-(pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productis) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich productis).

 

Limited product The SFA does not have access to a
compliant whole grain-rich productls} in the local market and
would like to offer enriched grain item(s) temporarily.

Tornado Wraps

 

 

 

Unacceptable product quality: The whole graln~rich productls}
offered by the SPA did not retain the desired texture or lost
palatabllitv during the typical holding time.

 

Tornado Wraps

 

Yes



List the type of grain productls)
to be exempted {attach
production record):

 

Poor student acceptability: The whole grain-rich productls)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich productls) was offered multiple times
and over a sustained period of time.

Tornado Wraps

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item

Product Description Manufacturer

Product Code

 

WG Breakfast Taco

WG Rolled Taco Egg, Ruiz

Sausage, Cheese, and Potato

41525

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that ail records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

fr. 
ll 330% Kg

      

 

Signet re of Director of Sc oots Date 
400% 4i .2 ~35 I '0
Approved Progrem Manager 5 I Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

 

 

Steven L. Beshear . Terry Hoiliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 More Street - Frankfort, Kentucky 40601
Phone: (502) 564-4770 0 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015?2016

l, Lisa McCarty as the duly authorized representative of Owenshoro ind Schools Name}, do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring compliant whole
grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich product{s) for
the remainder of SY 20111-2015 and SY 2015?2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain pro'ductls) to be
exempted.

KentuckyUnbridiedSpirit.corn An Equal Opportunity Employer MIFJD

 
   

5mm 

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardship(s):
etc. for documentation]:
Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich producds) was 
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich product(s). 
Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis} in the toes! market and
would like to offer enriched grain itemis} temporarily.
. Unacceptable product quality: The whole grain?rich product(s) Zesta Saltine Crackers
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.
List the type of grain product-(s) 
Yes Hardship(s): to be exempted (attach
production record):
Poor student acceptability: The whole grain?rich produc?s) Zexta Saltine Crackers
offered by the SPA received significantnegative student/parent

feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please llst):

 

 

List alternative product types! brands that have been utilized:

 

 

Grain Item Product Description Manufacturer Product Code
WW Crackers Crackers Whoie Wheat Westminster 30017
3 Make 1 Bread 7.59m Per
Package

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAS receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

58,; MW 9143

 

 

Signature of Director of Schools! Date

Vi baa/W1}! ?u .
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to, Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Stayen L. Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 More Street I Frankfort, Kentucky 40601
Phone: (502) 564-4770 0 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

i, Lisa McCari? . as the duly authorized representative of Owensboro Ind Schools Name], do hereby attest
that the aforementioned EPA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole
grain?rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235], Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grainvrich requirement in the meal programs, in school years (3Y8) 2014-2015 and 2015?2016, to a school food
authority that demonstrates a --'llp in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain producds), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 201341014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls) for
the remainder of SY 2014?2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productls} to be
exempted.

KentuckyUnbridied8pirit.com An Equal Opportunity Employer 

   

its UNBRIDLED 

 

YES

Hardship{s):

List the type of grain product(si
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain~rich product(s) was
offered.

 

Financial hardship: The EPA experienced a significant cost
increase when procuring the whoie grain-rich product(s).

 

.Limlted product availability: The SFA does not have access to a

compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

Chocolate Chip Cookie Dough

 

 

 

Unacceptable product quality: The whole grain-rich productts}
offered by the SFA did not retain the desired texture or iost
palatability during the typical holding time.

 

Chocolate Chip Cookie Dough

 

YES

Hardship(s):

List the type of grain product(s}
to be exempted {attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period oftime.

Chocolate Chip Cookie Dough

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
Chocolate Chip Cookie Dough W6 W6 Choc Chip Cookie Dough loz Otis Spunkrnever 55670
Carnival Cookie WG WG RF Carnival Cookie Dough 102 Otis Spunkmever 55673

 

 

 

 

 

 

 

Page 2 of 3

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAS receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain~rich.

 

liar! wj?kaCLA?C} 54,59 is
Signet re of Director of Schooi?~ Dat 
Jw. 5 a a; 

 

 

Approved Program Manager Date
*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 500 More Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-3141 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

Com
Saundra Bowman ?l 
as the duly authorized representative of 333 Elisha? Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for specific products if the SFA can demonstrate hardshipls). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. lfyour hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2015-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

mfg/*3

Emmy An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s): Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardship(s): record)-

 

Poor student acceptability: The whole grain-rich product(s) offered by Hamburger Buns;
the SFA received significant negative student/parent feedback or there Breakfast Biscuit
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types! brands that have been utilized:

 

Grain item Product Description Manufacturer Product Code

 

 

Hamburger Bun 4in - 51% Whole Grain Bimbo/Hamilton 3778
Breakfast Biscuit Whole Grain; 2 02: Easy Split Pillsbury 631 902

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Intormatton prowcleo above. that all
rec to support the information are available upon request by the State Agency.

6) km! IPH
Date

 
   

Signature of Director of School Nutrition Progra

2?271?

Program Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov



Karma}? 

545ar An Equal Opportunity Employer MIFID

 

 

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014~2015

Instructions: Submit a compieted waiver request form for each individual pasta product for which a
waiver is desired for 2014 2015. 

Sponsor Name: Owsley County School District

Name of Product a waiver is being requested for: Lasagna Noodles

Brand Name of product used: GFS brand Item Number 108197

Recipe(s) in which the product is used: Lasagna

Other products tested: Vendor does not carry a whole grain lasagna noodle

Issues with products used and tested: GFS does not carry a whole grain lasagna noodle. have checked
with several other manufactures and they do not carry a whole grain lasagna noodle either.

Internal Use Only

 

Date Submitted: Ll

Date Approved: 

Approving Signature: W4

m9 Mun/3W

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, Lynsi Barnhill, as the duly authorized representative of Paducah Independent Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that?are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

List
alte
mat
ive
pro

List the type of grain product(s) to
be exempted and attach

justification documentation
(production records, receipts,
photos, etc.):

Hardshipts):

 

 

Financial hardship: The SFA's records demonstrate a hggnificantdrop in i

meal counts after the whole grain-rich product(s) was offered. I


Ir Financial hardship: The SFA experienced a signi?cant cost increase 
'r when procuring the whole grain- r-ich product(s).

 

-I.-- 

 

h-

 

Limited product availability: The SFA does not have access to a 
:compliant whole grain- r-ich productts) in the local market and would
. like to offer enriched grain item(s) temporarily.
Preparation Hardship: Unacceptable product quality: The whole WG Biscuit
grain- -rich productts) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time. - WG Cracker

WG Tortilla

WG Pasta

 



List the type of grain product(s) to
be exempted and attach

a rd shi justi?cation (production records,
meal counts, student's letters,
surveys, etc.):

 

 

$oor student acceptability? The whole grain-rich product(s) offered by WG Biscuit
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain- W5 0301:2: :Igoducus) was offered mu tIple times and over a sustamed perIod we Tortilla

WG Pasta

 

Other hardship (please list):

 



 

 

duct types] brands that have been utilized:

My signature Indicates that I understand and attest to the accuracy or the Intormatlon provrded above. that alt
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Film e-io?ie

 

 

 

 

?S'ig?h?'ture of Director of School Nutrition Program Date

SUNIMC Program Coordinator/ Date

Please complete this form. Sign. and electronically submit to Sandy Wagner at Sandra.wagner@education kygov

 

 

 

 

 

 

 

I I
Grain Item Product Descrigtion Manufacturer I Product Code
. . . . . . GFS lit 618152
Biscwt Pillsbury 2.2 oz. biscuit General Mills GFS 866920
Cracker Saltine Cracker GFS GFS at 870400
Tortilla? 6? White Tortilla LaFronteriza 702633 1
Pasta 10 in. pasta spaghetti Kitchen Essentials GFS ll 654560 

 

 

 

 

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Moro Street I Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, Lynsi Barnhill, as the duly authorized representative of Paducah Public Schools, do hereby attest that the aforementioned
SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant whole grain-
rich products that are accepted by students, and that the factors indicated in this document pose a challenge in offering
whole grain-rich products. In Section 747 of the Appropriations Act provides flexibilities related to whole grains, sodium and
flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an In the appropriate column or columns (Yes) for each hardship
consideration. if your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33?2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpiril.com K01 way An Equal Opportunity Employer MIFID

SPIRIT

List the type of grain productis) to
be exempted and attach
justification (pictures, receipts,

Hardship(s):
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a significant drop in
meal counts after the whole grain-rich prod uct(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productis). l2]

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole WG Biscuit
grain-rich product(s} offered by the SFA did not retain the desired

texture or lost palatabllity during the typical holding time. W5 03?3?"

WG Tortilla

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hardship(s):
record):
Ear student acceptability: The whole grain-rich product(s) offered by WG biscuit 
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain- WG 03*?
rich product(s) was offered multiple times and over a sustained period
WG Tortilla
of time.
Other hardship (please list)?? 
. 
alternative product types/brands that have been utilized:
Grain item Product Description Manufacturer Product Code
Biscuit Pillsbury 2.2 oz. biscuit General Mills "Fits?11310034 I
Cracker Zesta Saltine Cracker Keebler Tits #113336
Tortilla? 6" White Tortilla Mexican Original #13399

 

 

 

 

 

 

 

I_v1y srgnature Indicates that I understand and attest to the accuracy or the Intormatron provrded above that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

35mm Bialn

 

 

 

 

?igh3ture of Director of School Nutrition Program Ij'ate
Program Cg?llnator Date 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentuckyUnbridledSpirit.com Km ("smart-y An Equal Opportunity Employer MIFID

 

Steven L. Beshear Terry Holiiday, PM).
Governor Commissioner of Education

AND DEVELOPMENT 
DEPARTMENT OF EDUCATION -

Capital Pia za Tower at 500 More Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-67?0 wmmducation.ky.gov

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015-2016

i, i3enny Holt, as the duly authorized representative of Padacah Puhiic Schools do hereby attest that the aforementioned
SPA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-rich products that
are acceptabie to students, and that the factors indicated in this document pose a chalienge in offering whole grain-rich
products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015 (Public Law 113-235},
Congress directed the Secretary of Agriculture to allow State Agencies that administer the National Schooi Lunch
Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory whole grain~rich
requirement in the meal programs, in school years (SYsl 20142015 and 2015?2016, to a school food authorityr (SPA) that
demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are aiiowed for any type of grain prodnct(s), leg, pasta, bread, brown rice, etc.) and for one
or more different products. SFAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 20134014 requirement of art-least half of the grains offered weekly are whole
grain?rich products. 

The State Agency will consider hardship factors in allowing an exem?tiori for the listed whole grain-rich productis} for
the remainder of 2014-2015 and SY 2015?2016. Place an in tile appropriate column or colamns (Yes) for each
hardship consideration. iiyotlr hardship is not listed, include in the other hardship section. List the grain product(s) to be I

exempted.

An Equal Opportunity Empioyer MIFJD

 

Yes

- 



List the type of grain protluctfs)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

'Flnancial hardship: The records demonstrate a significant

drop in meat counts after the whole grainerich productis) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich produc?s). El

 

Limited product availability: The does not have access to a
compliant whole grain-rich procluctis) in the local market and
would like to offer enriched grain itemis) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich productis)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

Whole grain crackers for salads and
a few alternate entrees

 

Yes



List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain~rich productis)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain~rich prociuctis) was offered multiple times
and over a sustained period of time. 

Whole Grain Crackers for salads
and other entrees-such as cheese
and crackers and peanut butter and
crackers. Students do not like the
whole grain crackers and too many
must be given to meet guidance
elevating cost, calories and sodium

 

 

 

 

 

Other hardship {please list}:

 

 

list alternative product types/brands that have been utilized:

 

Grain item

Product Description Manufacturer

Product Code

 

Saltlne Cracker

individual Wrapped Keebler

Saltine crackers

01446

 

 

 

 

 

 

 

 

 

 

 

Page 2 of 3

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that at! records
to support the information are avaitabie upon request by the State Agency, and that the SFAs receiving theexemption
must ensure that at Ieast half of the grain items offered weekly is whote grainwich.

(XL-M helm 

Signa?JIUI/ez 

Approved program Manager

 

   

*Ptease compiete this form, Sign, and electronicaliy submit to Sue Bartenfield at 

is an equa! opportunity provider and employer.?

Page 3 of 3

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

1 April Gross Paris Ind. Schools

as the duly authorized representative of Name},
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain?rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grairvrich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014?2015, 2015-2016 and
2016?2017 to a school food authorityiSFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate coiumn or columns (Yes) for each hardship consideration. if your hardship is

not listed, include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain productls}
to be exempted and attach 
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich productls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

EDD

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and
would like to offer enriched grain itemls) temporarily.

Uncle Ben's Mexican Fiesta
Rice

 



 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SPA did not retain the desired texture or iost

 

 

Yes

during the typical holding time.

Hardship(s):

List the type of grain product(s)
to be exempted-(attach
production record):

 

Poor student acceptability: The whole grain-rich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list]:

 

 

List alternative product types/brands that have been utilized:

 

Grain itern Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half ofthe grain items offered weekly is whole grain-rich.

 

 

1 1/1 6/1 6
WW

Program Coo rdinatgrw Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

l, Lisa Mitchell as the duly authorized representative of Pendleton County Board of Education do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017?18.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. lfyour hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32?2017
SP 33-2016

Md} 
KentuckyUnbridledSpirit.con1 qg,mo swan-y An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to be
exempted and attach justi?cation
(pictures, receipts, etc. for
documentation):

 

Financial hardship: The records demonstrate a significant drop in meal
counts after the whole grain-rich product(s) was offered.

We have shown that we have had a drop in
participation on taking Whole grain
products Pasta, Biscuits, Bagels, and
crackers compared to White products in
the same form.

Our students will take the Whole Wheat
Bread, Hamburger and Hot Dog Buns. So
we will continue to serve those products.
We can also use the Penne Noodles in
Multi Grain.

 

Financial hardship: The SFA experienced a signi?cant cost increase when
procuring the whole grain-rich product(s).

Whole grain products are a little more
costly but we have not had a problem at
this time ?nancially.

 

Limited product availability: The SFA does not have access to a compliant
whole grain-rich product(s) in the local market and would like to offer enriched
grain item(s) temporarily.

Noddle Lasagna not available (See below)

 

 

Preparation Hardship: Unacceptable product quality: The whole grain?rich
product(s) offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

It had a nasty texture and taste was
terrible students would not take the
product.

 

Hardshipls):

List the type of grain product(s) to be
exempted (attach production record)

 

Poor student acceptability: The whole grain-rich product(s) offered by the SF


received signi?cant negative student/parent feedback or there was increased?~

Biscui?t all schools

plate waste of that menu item when the whole grain-rich product(s) was Grader? 
offered multi le times and over a sustained eriod of time. 
Pasta at schools(Spaghetti, Lasagna,

macaroni, Egg Noddle)

5? Bagels gangh School

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
100 96 durum Lasagna ridged curly GFS 108197 order code
Wheat Semolina
Enriched Flour Pillsbury Southern Biscuits GFS 618162 order code

bleached, Wheat
?our, malted Barley
?our

 

 

 

 

 

 

 

 ?00- to

support the information are available upon request by the State Agency. and that the. exemption must ensure that at
least half of the grain items offered weekly are whole grain rich.

mm Season

 

 

 

Signature of Director of School Nutrition Program Date
9?9} /7
Program Goffrdinator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education ky.gov



com UNBRIDLED An Equal Opportunity Employer MIFID

r? Hutu-Invin- Qnoms hall IHUUO you on

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015. -

Sponsor Name:

Pendleton County Schools

Name of Product a waiver is being requested for:

Elbow Macaroni

Brand Name of product used:

Barilla

Reclpels) in which the product is used:

Macaroni Cheese

Other products tested:

GFS Brand

Issues with products used and tested:

Bitter flavor that over powers the cheese flavor. Noodles did not hold well, fell apart and became
mushy.

Internal Use Only

 

Date Submitted: '11

Date Approved: 

Jam 

Don Parkinson

Matthew G. Bevin Secretary

 

 

Governor Education and

Workforce Development Cabinet

Wayne D. Lewis
interim Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
2 Hudson Hollow Suite . Frankfort. Kentucky 40601
Phone: (502) 554-5525 0 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

Henge . as the duly authorized representative a?ergg ?25.33; Name], do hereby attest
that the aforementioned SPA and all schools under its jurisdiction demonstrate a dship in procuring, preparing, or

sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2013-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.


KentuckyUnbridledSpiritcom An Equal Opportunity Employer 

UWIRIT

Hardshipls):

List the type of grain productfs) to
be exempted and attach
justification documentation
[production records, receipts,
photos, etc.):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(5) was offered.

mm ?mm?

mm :5an WSWN

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

mu madam wow
35

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls] in the local market and would
like to offer enriched grain itemls) temporarily.

33h El?i?.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardshipls):

List the type of grain product(s] to
be exempted and attach
justification (production records.
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Wm groom oil-mm
Wu (sabotage-

mm cyan-x :93ka

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
mythat at teas half of the grain items offered weekly are whole grain rich.

. 

 

 

 

Slgnature of Director of School Nutrition Program Date
scmM?c Program Coordin ?Date I

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@ed ucation.l<y.gov

i
mm An Equal Opportunity Employer MIFID

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113~234, for school food
authorities to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016?17. All temporary approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency. 

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productisl for the

2016-17 school year. This extension will he in effect for the 2016-17 school year and the SFA is responsible for ensuring
availabilig of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich reguirement

for the 2017-13 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain

an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. Poor Student Acceptability, Other) Tried and Were not Accepted
33-3 Wk Sins? LQC. 1231?ka

?k?wm oxts? ukk??:?h
)3 3 ?Willow DLJZUA

 

 

 

entomo- . we aces-72o
Doe? (their mm 0330?
- Simon} hi0. c330 . :5
her ?were NJ if?" CM km?
?W?Wv?icybr 3w 4 Li 3? $12? 7

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

Nw?/aghdm/M 7, 2r~ 2m

Director of Schools Date

 



SCN7MC Frogrgm Coordii?tor Date

 

*Please complete this form, sign, and electronically submit to Sandy Wagner at .

is an equal opportunity provider and employer.?

Page 1 of1

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and Schooi Breakfast Program (SBP) through the school year 2016-11 Ali temporary approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed Whole grain-rich product(s) for the

2016-17 school year. This extension will be in effect for the 2016-17 school year and the SPA is resgonsibie for ensuring
availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich reguirement

for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as weiias
other products/brands tried in the proper columns beiow.

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain

an Extension of Waiver is Hardship, Limited Product Availability, Products/Brands That Have Been
requested. . Poor Student Other) Tried and Were not Accepted
Sus nematode-r as gas?? ma ?ght??

65:1 ?recs-e one tom?s- is Mtge ?Reach

 

 

 

"Mignon ubizuq
9.313% 112,? (7D . we gems 
?Shrink wkuec}tom L03 We.)
65 NJ mu. tom. 
?perouortostw. ?swam-w
tr

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records to,
support the information are available-upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

Nauru-? 

 

Director of Schools Date
of? 2 "2 
Still/WE Program Coordi tor Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer."

Page 'l of?!

 

Steven L. Beshear Terry Holiiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mero Street . Frankiort. Kentucky 40601
Phone: (502) 554-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

the duly authorized representative of Name], do hereby attest
tt aforemention SFA all schools under its jurisdiction demonstrat a hardshi in procuring compliant whole

grain-rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to

students.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipts).
The temporary exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole

grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls} for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be

exempted.

KentuckyUnbridledSpirit.corn An Equal Opportunity Employer 



list the type of grain productis)
to be exempted and attach
justi?cation (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardshipts): 
etc. or ocumentation 
(if? 3306?!
Financial hardship: The records demonstrate a signi?cant 
drop in meal counts after the whole grain-rich productis) was (of 39/ 7716M
offered. 73 49/577 /7W?k%
Financial hardship: The SFA experienced a signi?cant cost 
increase when procuring the whole grain-rich productls). 
Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and
would like to offer enriched grain itemls) temporarily.
Unacceptable product quality: The whole grain-rich productls) We?
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.
list the type of grain product(s}
Yes Ha rdshipi to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SPA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.







 

 

 

Other hardship (please list):

fmi??

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

3?73?0

Grain Item Product Description Manufacturer Product Code
4?65 r7/1 LU 6~5?au1e ?m?jmdd?cf 
xvii/x

wa ?Swami?

093/5

 

 

0% 43/0

 

 

 

000; 51% 



 

9Q 5(02 

 

Page 2 of 3



My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

WA J/f/

  

 

 

ignat?ure of Director oliSchoGls Date 
. I a 'l
M?cm 0mm More
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Sue Barten?eld at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Request for Exemption for Whole Grain-Rich Requirements

School Year 2018-19
I, Lisa as the duly authorized representative of Pike County School Food Service do hereby attest that the

aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,

and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018?19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.





 



Hardshipls):

List the type of grain productis) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls] temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SFA did not retain the desired
?xture or lost palatability during the typical holding time.

 

 

 

 

Hardshipis):

List the type of grain productis) to
be exempted and attach
justi?cation (production records,
meal counts, student?s letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich prod uctls) offered by
the SFA received signi?cant negative student] parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustainedperiod
of time.

Hamburger Buns
Hot Dog Buns

Sandwich Bread

 

Other hardship (please list):

 

 

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Hamburger Buns 4" Whole Grain (51% whole Bimbo Bakery #3447 
grain)
Hot Dog Buns Whole Grain (min 51% whole Bimbo Bakery #4266
grain)
Sandwich Bread Whole Grain White (min 51% Bimbo Bakery #3239
whole grain)

 

 



 

My signature Indicates that I understand and attest to the accuracy or the Intonnatlon prowoeo above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

Egg/u ?aw (ta/MW?

Signature of Director of School Nutrition Program Date



SCN Prt?rarn Date

 

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandrawagner@education.ky.gov

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mare Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, as the duly authorized representative of WSW. Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hards ip in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

Karma-?egg? it

UNBRIDLED SPIRIT

List the type of grain product(s) to
be exempted and attach

Hardshipm: justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop In
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired SE2 WW
texture or lost palatability during the typical holdingtime. W85

 

 

 

 

List the type of grain product(s) to
Hardship(s): 23:31! ptecl (attach production

 

Poor student acceptability: The whole grain-rich productls) offered by 826 I I 71..
the SFA received signi?cant negative student/parent feedback or there ?12
was increased plate waste of that menu item when the whole grain- LEWIS

rich product(s) was offered multiple times and over a sustained period
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

)0}in WG- ?pIIHSbuf'L?i 
gist/14H Pill-shard NG- pilbburq #123 JOIOQ.

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided aboveI that all
record 0 support the Information are available upon request by the Slate Agency.



Signature of Director of chool Program Date

 

 

All/w /7

SC 0 Prog'l?a?m Coynator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

Karmic? is

5mm?- An Equal Opportunity Employer MIFID

KentuckyUnbridledSpiriL com

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Hero Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, as the duly authorized representative of pm SFA Name], do hereby attest
that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hards ip in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document

pose a challenge In offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

may approve an exemption request for speci?c products if the SPA can demonstrate hardshipls). The
exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school yea r. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your ha is not
listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

a? 
M?pmg An Equal Opportunity Employer MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s): Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich product(s) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s] temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired Qa MW

 

 

 

 

texture or lost palatability during the typical holding time. 
List the type of grain product(s) to
Hardship(s): be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s} offered by 5 4
the SPA received signi?cant negative student/parent feedback or there 62!. 
was increased plate waste of that menu item when the whole grain-

product(s) was offered multiple times and over a sustained period Aekrs
of time.

 

Other hardship (please list):

 

 

 

 

List alternative product typesibrands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

Margfon} we 3&5! 
5/

ann? MP 57% 6mm

 

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy of the Information provided above. that all

record to support the information are available upon request by the State Agency.
M/dm/ ll l7lam7

Signature of Dlrector of School Nutrition Program Date

 

 

4254 

Coordiia?tor Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

1?qu 
KentuckyUnbridledSpiritcom 5mm? An Equal Opportunity Employer MIFID

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mare Street 1: Frankfort, Kentucky 40601
Phone: (502) 564-3141 vmw.education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, 5?5.ng [m as the duly authorized representative of Erik?) Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. In Section 747 of the Appropriations Act provides fiexibilities related
to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
remainder of SY 2015?2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under 5P 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32-2017
SP 33-2016

rude 
KentuckyUnbridledSpiriLcom 0' a An Equal Opportunity Employer MIFID

UNBRIDLED 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure the least half of the grain items offered weekly are whole grain rich.

Ora/~? 

chool Nutrition Program Date

  

1424 an/ hop-4;

Program Coordiy??tor Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@educatlon.ky.gov

\zxyi?sx
miude 
UNERIDLED smm-r .. An Equal Opportunity Employer 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

CUR. I reoxtcesk
Wit-Hm most is.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain?rich product(s).

OLE-3- .
New 05

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardship(s):

List the type of grain product(s] to
be exempted (attach production
record}:

 

Poor student acceptability: The whole grain-rich product(s} offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

The. Erma):
B?scm' i 

 

 

Other hardship (please list):

S?l-Ldeuif.
QMSwer
50er 

do Mo-l
lilCe WC {is

 

 

List alternative product typesIbrands that have been utilized: ?he/?00?

dWou

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, gm? 11g 3 as the duly authorized representative of 4? Name],
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

l?

Ha r?rhipts):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

.-.ancia  hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich productls) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich productls) in the local market and
ould like to offer enriched grain itemls) temporarily.

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich productls)
offered by the SFA did not retain the desired texture or lost

 

palatability during the typical holding time.

 

 

 

 

Yes

Hardshipls):

List the type of grain productis)
to be exempted (attach
production record):

 



student acceptability: The whole grain-rich productls)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain?rich productls) was offered multiple times
and over a sustained period of time.

weaken-Wm

w? rem gt!

 

 

 

Other hardship (please list):

71? K94 kWh,
Vnofueff.h/4



 

 

List alternative product types/brands that have been utilized:

 

 

Grain Item

Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

Page 2 of 3



My signature indicates that I understand and attest to the accuracy of the information provided above, that all records

to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

l~ 3 l-?l 
orofSchools k-

Date


?s7/?Djlt97
Sandy Wagner at 

  


*Please complete this form, sign, and electronically submit to

is an equal opportunity provider and employer.?

Page 3 of 3

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Eievin
Governor

 

Wayne D. Lewis
interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite I Frankfort. Kentucky 40601
Phone: (502) 564-5825 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

    

as the duly authorized representative of Name], do hereby attest
that the aforement ned and all schools under its jurisdiction demonstrate a dship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productts], pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

KentuckyUnbridledSpiriLcom Km anemone An Equal Opportunity Employer MIFID

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

/0 ?Ma?a 

?Signat?re of Director?f School?utrition Program Date

 

 

Program Coordinator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Hardshipls):

list the type of grain productls) to
be exempted and attach
justi?cation documentation
[production records, receipts,
photos, etc):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productis) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

KentuckyUnbrid

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 



 

Hardship(s):

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.



 

 

Other hardship (please list):

[(011qu 57??
edSpirit.com unampceo 

 

An Equal Opportunity Employer MIFID

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

10 

Signature of Director of #00! Nutrition Program Date 

awe/>7?

Program Coord?ator Date

 

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

list alternative product types/ brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

Bursar We Elm-r View?? 44592?3229?
eswe we may 'Peadt usual, WWM M, 

 

 

 

 

 

 

 

 

Kmerygf' 3?

momma 5mm:- An Equal Opportunity Employer MIFID

KentuckyUnbridledSpirit.com

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum 31933?2016 extends the ability, previously authorized by Section 751 of Public taw 113?234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch 9rogram
(NSLP) and School Breakfast Program (SBP) through the school year 2016?17. All temporary approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich productls) for the
2016-17 school year. This extension will he in effect loathe 2016-17 school year and the SFA is responsible for ensuring
availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement

for the 2017-13 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below. 

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain
an Extension of Waiver is Hardship, Limited Product Availability, That Have Been
requested. Poor Student Acceptabllity, Other) Tried and Were not Accepted
Whole Grain Biscuits Poor Student Pillsbury WG Biscuits

Heritage WG Biscuits

 

 

 

 

 

 

 

 

 

 

igl??'f??dual hop?ortu?ityprovide'ransignature indicates that understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

 

 

Lucille Hudson 06/24/2016
Director of Schools Date

KWWM M, (2 
Program Coordingn?l? Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

 

Page'i of 1 

 

Hal Hefner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mare Street Frankfort, Kentucky 40601
Phone: (602) 564-3141 I 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017?18

1, Lucille Hudson, as the duly authorized representative of Pulaski County Schools, do hereby attest that the aforementioned
SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or serving compliant whole grain-
products that are accepted by students, and that the factors indicated in this document pose a challenge in offering
whole grain-rich products. In Section 747 of the Appropriations Act provides flexibilities related to whole grains, sodium and
flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in aiiowlng an exemption for the listed whole grain-rich productis) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017

SP 33-2016

[(91 ck 
KenluckyUnbridledSpiritmm momma-o An Equal Opporlunity Employer 

List
alte



List the type of grain productis) to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

FFinanciai hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich product(s) was offered.

Students did not accept whole grain
biscuits, pasta, lasagna, macaroni,
spaghetti and brown rice.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productis).l

The cost of whole grain rich products is
much higher than enriched grain
products.

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched graln_item(s) temporarily.

 

 

 

Preparation Hardship: Unacceptable product quality: Themole
grain-rich product(s] offered by the SFA did not retain the desired
texture or lost during the typical holding time.

 

 

The whole grain product is darker in
color and does not have a good
texture or taste.

 

 



 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
product(s) was offered multiple times and over a sustained period
of time.

List the type of grain productis) to
be exempted (attach production
record):

 

Whole grain biscuits and pasta is not
accepted by students. If they chose it,
it goes in the trash can.

 

 

Other hardship (please list?):

 

 

.. 

rnative product types/brands that have been utilized:

 

Whole grain pasta products are not
always available when ordered.
Sometimes you have to special order
an Item and sometimes a case is more
than is needed.

 

 

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Spaghetti Spaghetti Barilla 468693
Macaroni Macaroni Barilla 313893
Lasagna Lasagna Patrla 384805
Noodles Noodles Luigi 251646
Biscuits Biscuits Pillsbury 370866 

 

 

 

 

 

 

 

 

My signature Indicates that I understand and attest to the accuracy or the intermatlon provrded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.



Signature of Director of School Nutrition Program Dale

(La/okay Mi?

Program Cod?dinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

 

 

 

 

 

 

 

 

 

 


KantuckyUnbridledSpiritcom Wigwam spmy An Equal Opportunity Employer MIFID

My Signature Indlcates that I understand and attest to the accuracy or the Intormatlon prowded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

 

 

53 mm? {gd?gmgg 
Ignature of Director of School Nutrition Program Date

 

 

SCNIMC Program Coordinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

(k 
?53?ngng An Equal Opportunity Employer MIFID

 

Steven L. Beshear Terry Phi).
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EBUCATION

Capital Plaza Tower . 500 Mere Street a Frankfort, Kentucky 40601
Phone: (502) 564-4770 0 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014-2015 and 2015-2016

I, Lucille Hudson, as the duly authorized representative of Pulaski County Schoois, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whoie grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
{Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain?rich requirement in the meal programs, in school years (SYs) 2014?2015 and 2015-2016, to a schooi food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are aiiowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the SY 2013-2014 requirement of at least half of the grains offered weekiy are whole
grain?rich products. .

The State Agency will consider hardship factors in aiiowing an exemption for the listed whole grain?rich product(s) for
the remainder of SY 2014?2015 and SY 2015?2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, inciude in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

   

UNBRIDLED SPIRIT -

Yes

Hardship(s):

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

YES

Financial hardship: The records demonstrate a significant
drop in meai counts after the whole grain-rich productls) was
offered.

Biscuits

 

YES

Financial hardship: The SFA experienced a significant cost
increase when procuring the whoie grain?rich product(s).

Whole grain biscuits are much
higher than wheat biscuits.

 

Limited product availability: The SFA does not have access to a
compliant whole grain?rich product(s) in the iocal market and
would like to offer enriched grain itemls) temporarily.

 

Yes

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
during the typical holding time.

 

Biscuits become very hard after a
short time out of the oven.

 

 

Yes

Hardship(s):

Whole Grain Biscuits

 

Yes

Poor student acceptability: The whole grain?rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

Whole Grain Biscuits are not well
accepted by students. if you make
sausage biscuits, a lot of students
wiil take the sausage out of the
biscuit and eat the sausage but
throw the biscuit away. If you serve
them separateiy, they wili not
aiways take the biscuit. The
students always take the cereal of
the morning.

 

 

 

Other hardship (please list):

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Biscuits Biscuit Pillsbury 32268
Biscuits Biscuit Heritage 353572

 

 

Page 2 of 3

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

Lucille Hudson 

 

Signature of Director of Schools Date 
.3 we
Approved Program Manager Da 

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Steven L. Beshear Terry 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mere Street - Frankfort, Kentucky 40801
Phone: (502) 564-4770 0 

Request for Exemption for Whole Grain?Rich Requirements
School Years 2014?2015 and 2015-2016

l, Lucille Hudson, as the duly authorized representativ?ounty Schools, do hereby attest that the

aforementioned SFA and all schools under its jurisdiction demr . - a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate 
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grainorich productis) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

An Equal Opportunity Employer MIFID
UNERIDLED SPIRIT 

YES

Hardship(s):

List the type of grain productis)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

YES

Financial hardship: The records demonstrate a signi?cant
drop in meal counts after the whole grain-rich productis) was
offered.

Pasta, lasagna, macaroni, spaghetti

 

YES

Financial hardship: The SFA eXperienced a signi?cant cost
increase when procuring the whole grain-rich product(s).

Whole grain pasta is not acceptable
to the students

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productis) in the local market and
would like to offer enriched grain itemis) temporarily.

 

Yes

 

 

Unacceptable product quality: The whole grain-rich productisi
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

The whole grain pasta is dark and
does not have a good texture or
taste.

 

Yes

Hardship(s):

Whole Grain Pasta

 

Yes

Poor student acceptability: The whole grain-rich productis)
offered by the SPA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multiple times
and over a sustained period of time.

Whole Grain Pasta is not accepted
by the students. If they chose it, it
goes in the garbage can.

 

 

 

Other hardship (please list):

 

Whole grain pasta products is not
always available when ordered. You
lose sales when students can't have
what they prefer.

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Spaghetti Spaghetti Barilla 468693
Macaroni Macaroni Barilla 313893
Lasagna Lasagna Patria 384805
Noodles
Noodles Luigi 251646

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly ls whole grain- -rich.

Lucille Hudson 

Signature of Dir ctor of Schools Date 


Approv Program Manager? Date

 
 

 

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne [3 Lewis
interim Commissnoner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort, Kentucky 40801
Phone; (502) 564-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

as the duly authorized representative of Name], do hereby attest
that the a orementloned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or

serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FMS-20170021, 7 CFR Pam 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exempdon for the listed whole grain-rich productis) for the

2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

(uric?
KentuckyUnbridledSpirii.com macro amen- An Equal Opportunity Employer 

Hardshipls):

List the type of grain productis) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc]:

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productis] was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis). l3

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productisi in the local market and would
like to offer enriched grain itemis) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productisi offered by the SFA did not retain the desired
texture or lost during the typical holding time.

 



 

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich productis) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productts] was offered multiple times and over a sustained period
of time.

rum a. My
go? 210 

Deal/\?

 

 

 

 

 

 

 

 

Other hardship (please list}: 
W, 
M4 ml;
List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
F/m/ Mad Hm; 4 Fair/5M 6E5 z; 18 15-2.

 

 

{Aw

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the infonnatlon provided above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

ML we

Signature of Director of School Nutrition Program Date

  

. 40 {Fig
Coordinator WW Date $67?

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wegner@educetion.ky.gov

 

A
rude?
KentuckyUnbridiedSpirit.com mm? An Equal Opportunity Employer WFID

 

Matthew Bevin Stephen Pruitt, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street a Frankfort. Kentucky 40601
Phone: (502) 564-4770 - 

Request for Exemption for Low-Fat Flavored Milk
For School Year 2017-18



I, \lggom y; Magnellas the duly authorized representative of Name], do hereby attest
that the aforementioned SPA and all schools under its jurisdiction demonstrate a hardship due to a decline in milk sales
or increased milk waste. Under Section 747(c) of the Appropriations Act, through 2017-18, the Division of School and
Community Nutrition, KDE will grant a School Food Authority an exemption allowing service of low-fat (1 percent milk
fat) flavored milk through the and the SBP 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.

 

 

 

 

 

 

 

 

 

 

Documentation Submitted
(invoices, waste study,
7?35 Hardship(s : production records, etc.)
Signi?cant decrease in milk sales since implementation of the
current meal pattern.
Declining milk sales despite offering alternative products and
brands.
A food waste study indicating signi?cant waste of ?uid milk. 'Plc-l-uv e. In" 
(nu a Quay
Signi?cant negative feedback from students and parents
regarding lack of availability of low-fat, flavored milk
Signi?cant negative feedback from students regarding the
palatability of fat-free, flavored milk.
KentuckyUnbridiedSpint corn An Equal Opportunity Employer MIFID

Karm?ry

My signature indicates that I understand and attest to the accuracy of the Information provided above, that all records
to support the information are available upon request by the State Agency.



 

 

Signature of Director of School Nutrition ProErarn Date
Adam, 3172
Apprr?red Program Managy Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.Wagner@education.ky.gov

is an equal opportunity provider and employer.?

Page 2 of 2

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, [kn-x; @ang Llas the duly authorized representative of Big ?sh) Name).

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act. 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

The State Agency may approve an SFA's exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products. and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for 
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed. include in the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes



List the type of grain productis)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich productisl.

 

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productisi in the local market and
would like to offer enriched grain itemis) temporarily.

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
palatabliity during the typical holding time.

 

whale grem
136m 

 

Yes



List the type of grain productls)
to be exempted (attach
production record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich productis)
offered by the SFA received signi?cant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productis) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list]:

 

 

List alternative product types/brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

 

    

 

..
MGM I (7
Director of Schools Date
51? 7
MC Program Coo nator Date

'Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Request for an Extension of Whole Grain Waiver Exemption

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SPAS) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016~17.Ali
temporary approved by a State agency under this superseded memorandum may continue under
the terms they were approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich
product(s) for the 2016-17 school year. This extension will be in effect for the 2016-47 school year and the
SFA is responsible for ensuring availability of whole grain rich products to meet the 100 percent of
grains offered must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other products/brands tried in the proper columns below.

 

 

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship, Limited Product Availability, Products/Brands That Have

Waiver is requested. Poor Student Other) Been Tried and Were not
?Accepted 

Biscuits Poor Student WG Biscuits

Breaded Chicken Poor Student Acceptability WG Breaded Chicken

Chicken Strips

Lasagna/Pasta Limited Products 100% we Pasta

Poor Student 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the Information are available upon request by the State Agency, and that the exemption must ensure that at

i set half ofthe grai items offered weekly are whole grain rich.
'l

 

 

 

 

 

ignature of Director of Schools District Date

.
a. ma. mam ave/c

Program Coordinator Date

Please compiete this form, sign, and eiectronicaiiy submit to Sandy Wagner at Sandra.wagner@educatton.ky.gov

 Prior Waiver Request for Whole Grain Rich Pasta 8? 2614-2015

Instructions: Submit a compieteri waiver request form for each individual pasta product for which a
waiver is desired for 2014 2015.

Sponsor Name: Russell County Board of EducationISchoOi Nutrition
Name of Product a Waiver is being requested for: {Eutr?e'lasagoa
Brand Name of product Food Service)

Reci'pe(s) in which the produtt is Comes iare?aSSerribiecianti ready to bake :zoon' deiivery
saving on and time {loo to (see attached spices)

Other products tested: Have searched for We preoaade product but none are availabie or on hid

issues with products used anti tested: in" the past, have made from scratch iasagna, hoWever due to
lunch scheduies, intensity and the'iizconsistency of amount-taste partitipation dropped.

Participation j?qeosedwiih the aromatic GFS yrociuct

 

internal Use Only

Date Submitted: "7 J7 520 L6
Date Approved: '1 <3 30 i if

Approving Slgnature: 5 

(7e7eiH)

@giw Vie/ma! con?rmim 
(lie c?iar

LoierLe mam moi/x pqyuo'is
Oww 0oVi3?dL ?nwwrih?

?id/96> Obit

 

 

Steven L. Beshear I Terry 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capltat Plaza Tower 6 500 More Street a raokfort, Kentucky 40601
Phone: (502) 564-4?70 6 Wtwreduoationkygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014?2015 and 20152016

i, Susan Melton, as the duly authorized representative of Russeil Countv Board of Education, do hereby attest that the
aforementioned SFA and all schoois under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consoiidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235], Congress directed the Secretary of Agriculture to allow State Agencies that administer the
Nationai Schooi Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whoie grain-rich requirement in the meat programs, in school years (5Y3) 2014-2015 and 2015?2016, to a schooi food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the 2013-2014 requirement of at ieast haif of the grains offered weekly are whoie
grain?rich products.

The State Agency wiil consider hardship factors in ailowing an exemption for the iisted whole grain?rich productls) for
the remainder of SY 2014?2015 and SY 20152016. Piece an in the appropriate column or columns (Yes) for-each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain productls) to be
exempted.

An Equal Opportunity Empioyer MIFID

   

UNBRIDLED SPIRIT -

 

 

 

.. 

 

 

 

List the type of grain produc?s) to be exempted and
attach justification (pictures, receipts, etc. for

 

 

 

 

 

Yes Hardshipls): documentation);
Financial hardship: The records demonstrate 3 Products requested to be exempt
significant drop in meai counts after the whole grain?rich WG Biscuits- WG Breaded Chicken Products if?)
productls) was offered. a; MW WW .. 
Based on the first 121 schooi days from 2013 2014
compared to 2014-2015 Russel! Co Schooi Food
Service has suffered extreme financial ioss as weii as
students not participating in the program.
(see chart below and attached REPORTS from P05)

Financial hardship: The SFA experienced a significant

cost increase when procuring the whoie grain-rich

productis I

Limited product availability: The SFA does not have

access to a compliant whole grain?rich productls in the

locai market and wouid iike to offer enriched grain

itemls) temporariiy.

Unacceptable product quaiitv: The whole grain-rich Based ona sampie of Student Letters (see attached)&

 

productls) offered by the SFA did not retain the desired
texture or iost during the typicai holding
time.

The products requested to be exempt are not offered
daiiy but when they are on menu they are paired with
another WG bread item such as roll, bun or breadstick

 

Managers comments of all the WG products the top
items requested to be exempted are: 

Breaded Chicken Strips and WG Breaded Fillet these
products tend to get rubbery, tough and breeding if
peels off

WG Breaded Strips paired with WG Roli

WG Breaded Chicken Fillet is aiso coupled with the WG
..Bun

WG Biscuits are not soft and fiakey, dark coloring gives
appearance of ?burnt? product-

 

 

 

 

sage: aeag 

 

?Ia-11,357 meag

 

?2,925 iess $70,150

meals served

 



i


 

 

 

 

iist the type of grain
productls) to be

 

Yes Hardshipls): exempted (attach
production record"):
Poor student acceptability: The whole grain-rich productls) offered by the SPA Breaded Chicken 

received significant negative student/parent feedback or there was increased plate
waste of that menu item when the whole grain?rich prodtictls) was offered multiple
times and over a sustained period of time.

New products are tested by students prior to placing on menu, as customers,
students were excited their voice was going to be heard regarding possible
exemptions. Thus a sample of their letters have been included as part of
documentation.

we Biscuits
*see attached student
letters 

 

 

 

 

Other Hardships

Due to the required Fruit [Vegetable at both meal services a significant cost is in
PRODUCE. Prior to students required to select a fruit/vegetable at breakfast as part of
the reimbursable meal the cost of Produce for entire school year (2913?2014) was

$58,637.

just for the first 121 days of 2014-2015 school year, Russell County School Nutrition
has paid out $71,403 in produce alone and there are still dig-days to attend.

in addition retention of highly trained quality staff has been a hardship this year. Due
to financial loss, and lack of participation based on Meals Per Labor Hour? employee
hours have been reduced as well as lay offs. Thus Administrative time has been iost
in training new employees before hire in the following areas:

a LEVEL 1, Food Service I

9 Confidentiality

9 Background check

a Physical

9 Blood Bourne Pathogens

?3 Promoting Positive Student Behavior on-iine training
0 Drug test

a Tax payroll paperwork

 

 

 

 

 

 

 

List alternative product types/brands that have been 

 

 

 

 

Grain Item, Product Description Manufacturer Product Code
Biscuit WG E2 Split Biscuit Generai Milis 132271000
Chicken Strips BRO WGRAIN Tyson 070332-0928
Breaded Chicken Patty CHIX PATTIE BRD WGRAIN Tyson 2154-0928

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that ail records
upport the information are avaiiabie upon request by the State Agency, and that the 5913 receiving the exemption
nus ensure that least haif of the grain items offered weekly is whole grain?rich.

Lea/1A. m5

?zz/(Emmet rofSchools Dat - 


Approved Program Manager Date

   
   
      
  

*Pieese compiete this form, Sign, and electronically submit to Sue Bartenfield at 

is an eqoai opportunity provider and empioyer."

WW mum? Mm .. ..M. 

 

 

 

 

Request for Exemption for Whole Grain~Rich Reqdirements
School Year 2016?2017

I, ?11,211 I2Q kg! as the duly authorized representative of; 5913 me FA Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a rdship in procuring
compliant whole graln~rich products that are acceptable to students, and that the factors indicated in this'document
pose a challenge in offering whole grainarich products. in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (S?fs) 2014?2015, 20154015 and
2016?2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole gralnwrich
products that are acceptable to students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate 
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain?rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or coIUmns (Yes) for each hardship consideration. if your'hardship is

not listed, include in the other hardship section. List the grain product(s} to be exempted.

*Reference: SP 33-2016

Page 1 of 3

List the type of grain productls)

to be exempted and attach

justification (pictures, receipts,
Yes Hardshipts): etc. for documentation):

 

Financial hardship: The records demonstrate a significant IO DA
drop in meal counts after the whole grain- -rich producds} was Phi) 
offered WV
Financial hardship: The SFA experienced a significant cost 
increase when procuring the whole grain-rich productis).

 

 

Limited product availability: The SFA does not have access to a
compliant whoie grain?rich productls) in the locai market and
would like to offer enriched grain itemls} temporarily.
Unacceptable product quality: The whole grain?rich productis)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 



 

 

 

 

 

List the type of grain productis)
to be exempted (attach

Yes Hardship(s): . . . production record):

 

 

Poor student acceptability: The whole grain-rich product(s) - 
offered by the SPA received significant negative student/parent Wiwi?a mi?
feedback or there was increased plate waste of that menu item 13 . .
when the whole grain-rich product(s) was offered multipie times QCA-M 
and over a sustained period of time.

Other hardship (please nethm '5 n0+ 

I More COmPlairxing

Milken {coir "trim
Wit? 

 

 

 

 

 

 

List alternative product typesibrands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code
aisc?lstlo we. 6?2 ear-t- l3 lemma Soaps
?gamers/enema we. Ede 012515
515?? ?taxessd?ri- LAG ?Stung gage?

have moi -i?O W41) io'?lnds 0v

Pa eZofS Math
a bi? )3 
it, pam?eudnd+ OLii Our?S?i? ?abmelr minim 5+ 
00+ scour/Lei OFUL

 

 

 

 

 

 

 

 

 

My signature indicates that understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
mu. sure that at least half of the grain items offered weekly is whole grain?rich.

we

Iv

   

 

(F 

so complete this form, sign, and electronically submit to Sandy gner at sandra. wagnerfcpeducation kv gov.

is an equal Opportunity provider and employer.?

Page 3 of 3 

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113?234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School Lunch Program
(NSLP) and School Breakfast Program through the school year 2016-17. All temporary fiexibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain?rich productis) for the
2016-17 school year. This extension will be in effectio?r the 2016 17 school veer and the SPA is responsible for ensuring
availability of whole grain rich products to meet the 100 percent of grains offered must be whole grain rich requirement
for the 2017- 18 school year

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

Grain Product for Continued Hardship (Financial Other Whole Grain That Have Been
which an Extension of Hardship, Limited Product Availability, Tried and Were not Accepted
Waiver is requested. Poor Student Acceptability, Other)
- A 0 We Mac Ghee so we
a Cc GCCeplabl ill L?lnc 
fl) 5+ QM TM Lola WC r1 Chases
F5 Spaqmih? cola i Laos-Bide mm

gr llshur Lot: 


 

 

[mt-9 'B'lSCuils
ich?s bola ibistuiis

 

Eliseo-t Poor Shiolodr (Merl-dottb

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

like; mews (atomic

 

Signature of Director of Schools Date
d/Aa/ 
Program Coordi?ator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 1 of ?l

 

Steven L. Beshear Terry Holiiday, 
Governor . Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 More Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-4770 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

lmi la maf?hCE?l/les the duly authorized representative of Name] do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship In procuring compliant whoie
grain- -rich products that are acceptable to students, and that the factors indicated in this document pose a challenge In
offering whoie grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain?rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), (e pasta bread brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products and must comply with the SY 2013? 2014 requirement of at ieast half of the grains offered weekly are whole
grain rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014 2015 and SY 2015? 2016. Place an in the appropriate column or columns (Yes) for each
hardship conSideration. if your hardship iS not listed include in the other hardship section. List the grain productis) to be
exempted.

KentuckyUnhridledSpiritcom An Equal Opportunity Employer MIFJD

   

  

ltl??l?i 01"? - 

I

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
iustification (pictures, receipts,
etc. for documentation):

 



Financiai'hardship: The records demonstrate a significant
drop in meal counts after the whole grain- ~rich product(s)l was
offered.

WU: 
Beam Come 



 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whoie grain- -rich productisil

?i0 Cirop

 

Limited product avaIlabIlIty The SFA does not have access to a

compliant whoie grain? ?rich product(s} in the local market and
would like to offer enriched grain item(s) temporarily.

 

 



I: Unacceptable product quality: The whole grain~rich product(s)
offered by the SFA did not retain the desired texture or lost

 


on m:

Items a Mug (go.

 

palatability during the typical holding time.

 

 

Yes

Hardship(s):



List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich productis)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich offered multiple times
and over a sustained period oftime.

1.0.4, 0AA WW
gmdemis $250+ 

Kids are. wme?zii?jgt'

aroma am on men 

it 

 

 

Other hardship (piease iwist)
067150 does not hold (item Ti I3 

i?nusi?t lo minutes we have Stopped
?hm wasiqiuied?1mg uatd iv WJLJ
mt {prina o9. (deride! or ?3 not? 5?
List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
I . . . . i?ito? 
{?ew beau/vb __l30iis 5I5IID Piusit)! gm Limo
Pasta, we aim? 931%th mildew Gina: We

Lid

 

 

 

 

 

 

 

PageZ of 3

My signature indicates that I understand and attest to the accuracy of the'information provided above, that all records

to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption

must ensure that at least half of the grain items offered weekly is whole grain-rich.

?imam, Maw - 34:] i106

Signature of Director of Schools Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

  
    

Approved Program Manager Date

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Heiner
Secretary
Education and

Matthew G. Bevin

 

Governor
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower 0 500 Mere Street a Frankfort. Kentucky 40601
Phone: (502) 564-3141 - 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
. Shelby County Public School:
I, Cindy Murphy as the duly authorized representative of Name], do hereby attest

 

that the aforementioned SFA and all schools under its Jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

may approve an exemption request for specific products If the SFA can demonstrate hardship(s). The
exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is not
listed, include in the other hardship section. List the grain productis) to be exempted.

Automatic extensions from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

Md} 5 c?
KentuckyUnbridledSpirit.com ?513,550 Emmy An Equal Opportunity Employer MIFID

Hardship(s):

List the type of grain product(s) to
be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productis) was offered.

The number of sludsnl breakfast with decreased

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

The texture and appearance of whole
grain biscuit is unacceptable to students.

 

 

Hardship(s):

List the type of grain product(s) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Peach Valley WG Biscuit and
Pillsbury WG Biscuit

 

Other hardship (please list):

 

 

 

List alternative product types/ brands that have been utilized:

 

 

 

Grain item Product Description Manufacturer Product Code
WG Biscuit Biscuit Dough, Frozen, we Peach Valley Bakery LLC PVB 
WG Biscuit Biscuit Dough. Frozen.WG Pillsbury 32268

 

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency.

Cindy Murphy 6-26?1 7

Signature of Director of School Nutrition Program Date

 

 

gag/xx 7-79-17

Progran'1 Coordinate? Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

(If 
KentuckyUnbridledSpirit.com An Equat Opportunity Employer MIFID

UNERIDLED SPIRIT

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016?2017

I, CI ndy urphy Shelby County Public Schools Name],

. as the duly authorized representative of
do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, In school years (5Y5) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productis) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship Is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33?2016

Page 1 of 3

Yes



List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 



Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain ltem(s) temporarily.

 

 

l'q

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
palata bility during the typical holding time.

 

WG Biscuit (Peach Valley)

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

WG Biscuit (Peach Valle)

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
WG Biscuit Biscuit Dough, Frozen, WG Peach Valley Bakery LLC PVB 
WG Biscuit Biscuit Dough.Frozen. WG Pillsbury 32268

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature Indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

 

   

My 12/15/16
Director of 55535)]5 ID??_ate
#7514

Date

 

Program

*Please corn piete this form, sign, and electronically submit to Sandy Wagner at sandra.wagnerQeducationkygov.

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 Mero Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017?18

I, Mark Thomas, as the duly authorized representative of Spencer County Public Schools, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document pose a
challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productts) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Reference: SP 32-2017
SP 33-2016

Km An Equal Opportunity Employer MIFID

Hardshipls):

 

I Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich prod uct(s) was offered.




 

List the type of grain productls) to

be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). 

 

Limited product availability: The SFA does not have access to a
compliant whole grain- -rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

man?nut

 

grain- -rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.



 

Hardshipls):

 

Preparation Hardship: Unacceptable product quality: The whole X- Biscuit

Please see attached two photos 8i


List the type of grain product(s) to
be exempted (attach production

record):

 

 

the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

Poor student acceptability: The whole gra-ihti'ich productls) offered by 

Biscuit

Please see attached photo 

 

 

Other hardship (please list):

 

 

list alternative product types/brands that have been utilized:

Grain Item Product Description I Manufacturer
I

Product Code

 

Biscuit 2.2 oz Southern Style Easy Split Pillsbury

'31524



 

 

 

 

 

 

 

My Signature Indlcates that I understand and attest to the accuracy or the rntormatlon prowcled above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?Zz ?ew Z-JCHX

 

 

 

 

Signature of Director of School Nutrition Program Date
3 
Program Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@educatlon.ky.gov

KenmJe E?s?

KentuckyUnbridledSpirit.com ?Magma;- swan-y An Equal Opportunity Employer MIFID

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

Hal Heiner
Secretary
Education and

Workforce Development Cabinet

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower a 500 More Street - Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for an Extension of Whole Grain Waiver Exemption

Memorandum extends the ability, previously authorized by Section 751 of Public Law 113-234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the school year 2016-47. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under the
terms they were approved, through school year 2016?17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich product(s)
for the 2016-17 school year. This extension will be in effect for the 201 647 schooi vear and the SPA is
responsible for ensuring availability of whole grain rich products to meet the 100 percent of grains offered
must be whole grain rich requirement for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as
well as other products/brands tried in the proper columns below.

 

Grain Product for
which an Extension of
Waiver is requested.

Continued Hardship (Financial
Hardship, Limited Product
Availability, Poor Student
Acceptability, Other)

Other Whole Grain

Accepted

That Have
Been Tried and Were not

 

Poor student acceptability, limited

Westminster WG Saltine

 

 

WG Crackers product availability, Financial Keebler WG Mini Saltine
hardship due to lower participation
Poor student acceptability due to General Mills WG Biscuit
WG Biscuits color and taste of product, Financial Rich?s
hardship due to decreased
participation
Poor product quality, financial Dakota Growers
WG Pasta hardship due to lower student Ultragrain

participation

 

 

 

 

 

 

 

KentuckyUnbridledSpirit.com

 

War/rig

An Equal Opportunity Employer MIFID

 

My signature indicates that understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?jg/W Pto?pa/ - I laaoxc

- Signatur?o?f Directot of Schools Date

 

Jpn? A 

Coordinate? Date 

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 

.-Steyen L. Beshear Terry Holiiday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION .

Capitai Plaza Tower . 500 Mere Street - Frankfort, Kentucky 40601
Phone: (502) 564-4?70 - myw.education.ky.goy

Request for Exemption for Whole Grain-RiCh Requirements
School Years 2014?2015 and 2015?2016

i, Kathy Phelps as the duly authorized representative of Taylor County hereby attest
that the aforementioned SFA and all schools under itsjurisdiction demonstrate a hardship in procuring compliant whole
grain~rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 1134235), Congress directed" the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (3Y5) 20144015 and 2015?2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardshipis).
The temporary exemptions are allowed fer any type of grain productls), leg, pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole
grain-rich products. .-

The State Agency will consider hardship factors in atlowing an exemption for the listed whole grain-rich productls} for
the remainder of SY 2014~2015 and SY 20152016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain product(s} to be
exempted.




KentuckyUnbridiedSpirit.com

  

An Equal Opportunity Employer MIFID

?nlml?r'

List the type of grain product(s)
to be exempted and attach
lustification (pictures, receipts,

 

 

 

 

 

 

 

 

 

 

 

Yes Herdship(s]:
etc. for documentation):
Financial hardship: The records demonstrate a significant Whole Grain Crackers, Biscuits-'8: 
drop in meal counts after the whole grain-rich product(s) was Pasta 
offered.
Financial hardship: The SFA experienced a significant. cost
increase when procuring the whole grain-rich product(s).
Limited product availability: The SFA does not have access to a
compliant whole grain~rich product(s) in the local market and
would like to offer enriched grain itemls) temporarily.
Unacceptable product quality: The whole grain-rich product(s) WG Biscuits&Pasta 
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.
List the type of grain productls)
Yes Hardship(s): to be exempted (attach
production record):
Poor student acceptability: The "whole graimrich product(s}
offered by the SFA received significant negative student/parent
feedbackor there was increased plate waste of that menu item we Biscuits! 935?
when the whole grain-rich produc?s) was offered multiple times
and over a sustained period of time.
Other hardship (please list): increased labor for staff in 
preparing additional offerings (such as grilled cheese on 
WG crackers

 

chili/soup day as a choice instead of the WG crackers.

i

 

- 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Crackers WG Saltine Westminster 198322
Crackers Saltine Mini WG Keebler 522150
Pasta Elbow Macaroni, Spaghetti, 8: Dakota Growers 229941, 221460, St 229951
Rotini WG
Biscuit WG Biscuit Dough General Mills 269210

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records 
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain?rich.

6&9le 1+3 430:5?

 

 

Sig ture irector of ?choois Date
1 
Approved Program Manager Date

*Please complete this form, sign, and electronically submit to Sue Bartenfield at 

is an equal opportunity provider and employer.?

Page 3 of 3

Hal Helner

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower 0 500 Moro Street . Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 
Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
Melisa: D. Wool?\WS as the duly authorized representative of ti Coda Name], do hereby attest

 

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides flexibilities related
to whole grains, sodium and flavored milk for school year (SY) 2017-18.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013?2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2016 and SY 2016?2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.

Automatic extension from SY 2016?17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017?18.

*Reference: SP 32-2017
SP 33-2016

A
(13% ,Lt-
InhrirllarlP-niril mm will An anal anlnver MIFID

List the type of grain product(s) to
be exempted and attach

Hardship(s}: justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in [able arm Dim

meal counts after the whole grain-rich productis) was offered. Effac?e? CU if ?at?

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain~rich productls). l3

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain item(s) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s} offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

 

 

List the type of grain product(s) to
be exempted (attach production

Hardship(s): record)?

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
oftime.

Other hardship (please list):

 

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Information provuoecl above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

We.? 1W 

Signature of Director of School Nutrition Program Date

4/444? 

SGNIMC Program Co?rtfinator Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov


Kenlunkul lnhrirtleriSnirit mm ll An Equal Opportunity Employer MIFID

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort, Kentucky 40601
Phone: (502) 564-5625 . mvw.education.ky.gov

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

?-gb?g I). N?g as the duly authorized representative of 954nm: Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain?rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim final rule from 7 CFR Parts 210, 215. 220 and 226 extends through school year 2018-19 the
menu flexibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whoie grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productis) to be exempted.

KentuckyUnbridledSpiritcom Km deyg An Equal Opportunity Employer MIFID

Hardshipls):

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a significant cost increase
when procuring the whole grain-rich productls).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich product(s) offered by the SFA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

Hardshipls):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productls) was offered multiple times and over a sustained period
of time.

7343+?, 5'
0&3de fender-5

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

Grain Item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

 

 

My Signature that I understand and attest to the accuracy or the inrormatlon prowded above, that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekty are whole grain rich.

MMW 34-741

 

 

 

 

Signature of Director of School Nutrition Program Date
44 Pearl?
Program Coordi or Date

Please complete this form. Sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

 

Steven L. Beehear Terry Holliday, Phi).
Governor . Commissioner of Education

AND WORKFORCE DEVELOPMENT 
DEPARTMENT OF EDUCATION

Capital Plaza Tower 9 580 Moro Street a Frankfort, Kentucky 40601
Phone: (502) 564-47i'0 wedmationkmgov

Request for Exemption'for Whole Grain-Rich Requirements
School Years 2014-2015 and 261?~2d16

i, Mt?ix?ysct as the duly authorized representative. of 713d; 13,13,233}? Name}, do hereby attest

that the aforementioned SFA and all schoois under its jurisdiction demonstrate a hard ip in procuring compliant whole
grain-rich products that are acceptable to students, and that the teams indicated in this document pose a chaiienge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235), Congress directed the Secretary of'?tgriculture to aliow State Agencies that administer the
Nationai School Lunch Program (NEW) and School Breakfast Program to grant an exemption from the regulatory
whole grain-rich requirement in the meat programs, in school years (5Y5) 2014?2015 and 20154016, to a school food
authority (SPA) that demonstrates a hardship in procuring compiiarrt whoie gra-inrrich products that are acceptable to
students.

The State A'gency may approve an exemption request for specific products if the SFAcan demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one
or more different products. SPAS granted an exemption must work with the State Agency to search for acceptable
products, and must compiy with the SY 2013?2014 requirement of at least half of the grains offered weekly. are whoie
gratn~rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whoie grain~rich product(s) for
the remainder of 2014~2015 and 2015?2016. Place an in the appropriate column or columns (Yes); for each
hardship consideration. if your hardship is not listed, include in the other hardship section. List the grain produc?s) to be
exempted.

KentuckyUnbddiedSpirit.com An Equal Opportunity-Emptwer MIFJD

 

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,

 

 

 

 

 

 

 

 

 

Yes Hardship(s):
etc. for documentation):
Financial hardship: The records demonstrate a significant 135:3 {Ltv??
drop in meat counts after the whole grain?rich product(s) was Chicken ?(3.42 V?j
offered.
Financial hardship: The SFA experienced a significant cost
increase when procuring the whoie grain-rich productls). 
Limited product The SFA does not have access to a
compliant whole grain-rich product(s) in the iocai market and
would iike to offer enriched grain itemis} temporarily.
Unacceptable product quality: The whoie grain?rich productls) 
offered by the SPA did not retain the desired texture or test 
palatability during the typical holding time. TE '5
List the type of grain ecodec?s}
Yes Hardship(s): to be exempted (attach
production record):
Poor student acceptability: The whole grainarich productis) $3ch at?
offered by the SFA received significant negative student/parent . 
feedback or there was increased plate waste of that menu item thigh ir\ A ch? 9* i) 
i/ when the whoie grain-rich productis) was offered muitiple times

and over a sustained period of time.

 

 

 

Other hardship (please list):

 

 

List alternative brands that have been utilized:

 

 

?31 eds: v5 NELSON

 

Grain Item Product Description Manufacturer Product Code 3
Ci?: eium 0/10 9ng,, 38/

 

eds?

 

 

 

'11? ?atcob?) E1 i?cicc?fii 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at least haif of the grain items ?offered weekiy is whole grain-rich.

?mama \39 mom) ?1132336

Sig ur ofDirectoro chools Date

37/5/15

Approved Program Manager Date
*Piease compiete this form, sign, and electronically submit to-Valerie Crouch at 

is an equal opportunity provider and employer.?

Page 3 of 3'

 

Steven L. Beshear Terry Holliday, 
Governor Commissioner of Education

EDUCATION AND WORKFORCE DEVELOPMENT CABINET
DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-4770 I: 

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-2015 and 2015-2016

t, Paula Dickerson. as the duly authorized representative of Trigg County Public Schoois. do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whoie grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015 .
(Public Law 113?235), Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and Schooi Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015 and 2015?2016, to a school food
authority (SFA) that demonstrates a hardship in procuring compiiant whoie grain-rich products that are acceptable to
students.

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole
grain-rich products. -

The State Agency wili consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for
the remainder of SY 2014-2015 and SY 2015-2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. if your hardship is not iisted, include in the other hardship section. List the grain product(s) to be
exempted.

KentuckyUnbridiedSpiritcom An Equai Opportunity Employer MIFID
UNBRIDLED 

ucky

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich product(s) was
offered.

 

Financial hardship: The SPA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain product(s)

to be exempted (attach

production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered muitiple times
and over a sustained period of time.

Whole grain tortilla wrap

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

Grain Item Product Description Manufacturer Product Code
WW Tortilla 10" WW Heat-Pressed Tortilla Tyson 7519-621
WW Tortilla 8? WW Pressed Tortilla Mexican Original 21113?621

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are availabie upon request by the State Agency, and that the SPAS receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

am.

Sign at of Director of SchoW Date
Approved Program Manager Date

*Please compiete this form, sign, and electronically submit to Valerie Crouch at 

is an equal Opportunity provider and employer.?

The cracks when rolled for the soft taco or the fajita chicken wrap. We throw many away because they
tear so badly. The 10" whoie wheat tortilla costs .28 white the white costs .15 each.

Page 3 of 3

The tortilla cracks when rolled for the soft taco or the fajita chicken wrap. We throw many away because they
tear so badly. The 10?.whole wheat tortilla costs .28 while the white costs .15 each.

Page 3 of 3

 

Hal Heiner

Matthew G. Bevin Secretary

 

Governor Education and
Workforce Development Cabinet
Stephen L. Pruitt, 
Commissioner of Education
KE NTUCKY DEPARTMENT OF EDUCATION
Ca pital Plaza Tower . see Hero Street . Frankfort, Kentucky 40501
Phone: (502] 504-3141 0 
Re?uest for Exemption for Whole Grain-Rich Requirements
School Year 2017-18
Paula as the :1 Lily authorized representative of Trigg Public ?ghggis. do hereby attest that the

 

aforementioned SFA and all oois under its jurisdiction demonstrate a hardship in procuring, preparing, or sewing
compliant whole grain-rich produ that are accepted by students, and that the factors indicated in this document pose a
challenge in 053008 Brain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (5y) 2017.13,

The State mav EIPPTOVE a exemption request for specific products if the SPA can demonstrate 
The temporary exemptions are al lowed for any type of grain product(s), pasta, bread, brown rice. etc.) and for one or
more different products. SPAS gra nted an exemption must work with the State Agency to search for acceptable products,
CDNPIY With the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
pro uc .

The State Agency 5'3"st ha rd ship factors in allowing an exemption for the listed whole grain-rich productls) for the
remainder Of SY 20154015 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consuderation. If your hardship ?5 listed, include in the other hardship section. List the grain product?s) to be exempted.

Automatic extension from SY 2015?17;

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
?80095! for Exemptions from the: School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms bY which they were approved, through SY 2017-18.

?Reference: SP 32-2017

SP 33-2016
lckUb'dled "co lialluo'ey . l'l'I'D
on Spirit at - Equa Opportunity Employer 



list the type of grain productls) to
be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

 

Financial hardship: The SFA's records demonstrate a significant-drop in
meal counts alter the whole grain-rich product(s) was offered.



 

Financial hardship: The SFA experienced a sign?ant cost increase
when procuring the whole grain-rich productls). 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain_it?mis3__temporariiv-

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productis} offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

 

 

Hardship(s):

salad, they still get soggy even when

 

Pretzel Rods have to be baked, cooled
and bagged before using with the chef 

bagged

 

List the type of grain productlsi to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich product(si offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

 

- Other hardship (please list}: Cost of product

 

 

List 

Requesting to use Saltlne Crackers.

wheat crackers are only packaged
?pack and 4.6 per package, 10
packages would be required to meet a
2 oz grain serving. Making the cost .68
per serving

 

 

alternative product types/brands that have been utilized:

 

Grain Item Product Description 1 Manufacturer

 

 

Product Code
Pretzel Rod WG soft pretzel rods 1 8: 1 Snack Food 31012
. - - I - - 
I Rolls WG Roll i Aunt Millie?s I 7388

 

 

 

I Scoops Baked Tdstito Scoops i Frito Lay 

l- 

425? 

My signature Indicates that I understand and attest to the accuracy or the Intormataon prowded above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

MWC Wu 

 

 

Signature of Director of School Nutrition Program Date

SCNIIVIC Program Coordinyf Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

An Equal Opportunity Employer MIFID
UNBRIDLED SPIRIT -

 

Request for an Extension of Whole Grain Waiver Exemption
School Year 2016-2017

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113-234, for school food
authorities (SFAs) to request exemptions from the whole grain rich requirements in the National School lunch Program
(NSLP) and School Breakfast Program (SBP) through the school year 2016-17. All temporary ?exibilities approved by a State
Agency under this superseded memorandum may continue under the terms they were approved, through school year 2016-
17, at the discretion of the State Agency.

The State Agency will consider hardship factors in allowing an extension for the listed whole grain-rich product(s) for the

2016-17 school year. This extension will he in effect for the 2016-17 school year and the SPA is responsible for ensuring
avallabilig of whole grain rich products to meet the 100 percent of grains offered must be whole gain rich requirement

for the 2017-18 school year.

List the grain products for which an extension is being requested and the continued hardship for consideration as well as
other products/brands tried in the proper columns below.

 

 

Grain Product for which Continued Hardship (Financial Other Whole Grain
an Extension of Waiver is Hardship, Limited Product Availability, Products! Brands That Have Been
requested. Poor Student Acceptabllity, Other) Tried and Were not Accepted
Whole Grain Tortilla Financial -ww 1e- .23 Bad]. While 10' .15 each Tyson 9519-621 1orww
sluden 
?mn ?gamma" 3mm and mm a Mexican Onglnal 21113-621 a
of waste 1mm tearing WW

 

 

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records to
support the information are available upon request by the State Agency, and that the exemption must ensure that at least
half of the grain items offered weekly are whole grain rich.

Dirt-0 ! ??nd 
l! mmamhymamm




 

Director of Schools Date

8?/l8 [lie
79

electronically submit andy Wagner at mdramag 

 
  
  

Program Coordinator
'Please complete this form, sign, a

is an equal opportunity provider and employer.?

Page 1 of 1

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016?2017

Count bl' Soho 
I, Paula as the duly authorized representative of ?99 0 Name],

do hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring
compliant whole grain-rich products that are acceptabie to students, and that the factors indicated in this document
pose a challenge in offering whole grain?rich products. tn Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235}, Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National Schooi Lunch Program and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meat programs, in schoolyears (SYs) 2014-2015, 2015?2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whoie grain-rich
products that are acceptabie to students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least hatf of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the iisted whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is

not listed, inciude in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

 

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich product(s) was
offered.

Whole Grain Biscuit

 

 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

 

 

 

 

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SPA did not retain the desired texture or lost

 

Whole Grain Biscuit

 

Yes

paiatability during'the typical hoiding time.

Hardship(s):

List the type of grain product(s)
to be exempted (attach
preduction record):

 

 

 

 

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whoie grain-rich product(s) was offered muitiple times
andoyer a sustained period of time.

Whole Grain Biscuit

 

 

 

Other hardship (please list):

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

Whole Grain Biscuit Biscuits, Buttermilk, we, TFF RS,Sliced Bake Crafters .

 

Grain Item Product Description Manufacturer Product Code
Whole Grain Biscuit Biscuit Bread Dough Pillsbury 32268
Whole Grain Biscuit Biscuit Dough Mary B's 8700

923

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain-rich.

Paula Dickerson 9/26/16

 

   

Director of Schoois Date

 

 

SCNl/MEProgram Coord?ator Date
*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equai opportunity provider and employer.?

Page 3 of 3

Hal Helner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower - 500 Mero Street 0 FrankfortI Kentucky 40601
Phone: (502) 564-3141 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I, Angela AdenS 

. as the duly authorized representative of Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides flexibilities related to
whole grains, sodium and flavored milk for school year (SY) 2017-18.

SCNIKDE may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s). The
exemptions are allowed for any type of grain productts), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33?2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-18.

*Refe re nce: SP 32-2017

SP 33-2016
I
fuck 
KentuckyUnbridledSpirit.com UNBRIDLED smm?r 1, An Equal Opportunity Employer 

List the type of grain productis) to
be exempted and attach

Hardship(s): Justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in

meal counts after the whole grain-rich product(s) was offered. grain 

 

Financial hardship: The SFA experienced a significant cost increase

when procuring the whole grain-rich product(s). WM en?s? ?131m" m? mm

 

 

Limited product availability: The EPA does not have access to a We have Access. just not accepted Bad
compliant whole grain-rich productis) in the local market and would Taste and appearance. Students dislike
like to offer enriched grain item(s) temporarily. and ?0 "0t 93' them-

 

Preparation Hardship: Unacceptable product quality: The whole we Biscuits are very dam? "alum and
grain-rich product(s) offered by the SFA did not retain the desired dry. Students dislike them and we have
texture or lost palatability during the typical holding time. '03 Pamc'pat?on ?1'3 days breakfas?

 

 

 

 

List the type of grain productis) to
Hardshipis): (attach production

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received significant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

See attached photos

 

Other hardship (please list):

 

 

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Biscuit Whole Grain Richs 09315

Biscuit Whole Grain Peach Valley Bakew LLC 
Biscuit Whole Grain Pillsbury-GeneraIMms 32268

 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all

reco to support ian a . ilable upon request by the 871a A ency-
no I. 9ch /7

Signature Fig/rector of S'c'hool Nutrition Program Da 

  

 

Date

 

rogram Coordinat

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

Kmrufa

mama? An Equal Opportunity Employer 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite - Frankfort, Kentucky 40601
Phone: (502) 564-5625 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

l, Shane Bosaw as the duly authorized representative of Union County Public Schools Name], do hereby attest
that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from 7 CFR Parts 210, 215, 220 and 226 extends through school year 201349 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SFA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,

and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

A 
en? Idea" 
KentuckyUnbridledSpiriLcom 

anemones sererr An Equal Opportunity Employer MIFID

List the type of grain productls) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc):

Hardship(s):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in
meal counts after the whole grain-rich productls) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). El

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain itemls) temporarily.

 

Preparation Hardship: Unacceptable product quality: The whole WG Biscuit
grain-rich productls) offered by the SFA did not retain the desired we Tortilla
texture or lost palatability during the typical holding time. we Pasta

 

 

 

 

List the type of grain productls) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc):

Hardshipls}:

 

 

 

 

 

 

 

 

 

 

Poor student acceptability: The whole grain?rich product(s) offered by WG Biscuit
the SFA received signi?cant negative student/ parent feedback or there we Tortilla
was increased plate waste of that menu item when the whole grain- WG Pasta
rich product(s) was offered multiple times and over a sustained period
of time.
Other hardship (please list]:
List alternative product types/brands that have been utilized:
Grain Item Product Description Manufacturer Product Code
Biscuit Southern-Style, Easy-Split, Frozen Pillsbury General 10094562315242 GFS #866920
2'2 02 Mills
Tortilla 6"-10" White Tortilla LaFronteriza 702633, 702668
Pasta Spaghetti, fettucine, macaroni GFS Brand GFS ii 108375, 201270, 413320

 

 

 

 

 

 

 

 

My Signature Indtcates that I understand and attest to the accuracy or the intormatlon provrded above, that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

$4 fir?Z; 

Sigr?ture of Di?sotor of School Nutrition Program Date



SCWC Program Coord??tor Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gou


KentuckyUnbridledSpirit.com An Equal Opportunity Employer MIFID

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower 0 500 More Street a Frankfort, Kentucky 40601
Phone: (502) 564-3141 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

I. as the duly authorized representative Name], do hereby attest

that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 747 of the Appropriations Act provides ?exibilities related
to whole grains, sodium and ?avored milk for school year (SY) 2017-18.

The State Agency may approve an SFA's exemption request for speci?c products if the SFA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grainarich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for the
remainder of SY 2015-2016 and SY 2016-2017. Place an in the appropriate column or columns (Yes) for each hardship
consideration. If your hardship is not listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extension from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2017-13.

*Reference: SP 32-2017
SP 33-2016

KentuckyUnbridledSpirii.com Km UNBRIDLED (user:rry An Equal Opportunity Employer WFID

List the type of grain productls) to
be exempted and attach

Hardshipls): justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productls) was offered.

 

A
Financial hardship: The SFA experienced a signi?cant cost increase Liv/3?5 (6::qu
when procuring the whole grain-rich productls). El ?1.42 Jud 9

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched_grain itemis) temporarily.

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability duringthe typical holding time.

 

 

 

 

 

List the type of grain productls) to
be exempted (attach production

Hardship(s): record):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SPA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

Other hardship (please list):

will. 0 Latch. lactate? A at. 
de?nite: (dim; 14,72? tact we], whim}? CL 6 602de

?(qum <fa+or ?i?ucbwi ad;

1.

bill! ?gt?im @4624}

 

 

 

 

 

List alternative product types} brands that have been utilized:

 

Grain Item Product Description Manufacturer Product Code

 

 

 

 

 

 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the Intonnatton provrdeo above. that all
records to support the information are available upon request by the State Agency, and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

YuLL/?luu??r- ?3 

 

 

 

 

Signature of Director of School Nutrition Program Date
Program %dinator Date

Please complete this form, sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

K01 An Equal Opportunity Employer MIFID

Matthew G. Bevin

Governor Hal Heiner

Secretary
Education and
Workforce Development Cabinet

 

Stephen L. Pruitt, 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION
Capital Plaza Tower'- son Hero Street - Frankfort. Kentucky 40501
Phone: (502) 584-3141 . 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

1. Ginatlmeacd. as the duly authorized rearesentan've do

hereby attest that the aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring,
preparing, or serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in
this document pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides
?exibilities related to whole grains, sodium and ?avored milk for school year 2017-18.

may approve an SFA's exemption request for speci?c products if the SPA can demonstrate hardshipis). The
exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the (SY 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productis) for the 2017/18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals? Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through SY 2012-18.

*Reference: SP 32-2017
SP 33-2016

A
KentuckyUnbridledSpirit.com Willa An Equal Opportunity Employer 

mm ?Hr

Hardship(s):

List the type of grain
product(s) to be exempted and
attach Justi?cation (pictures,
receipts, etc. for
documentation):

 

Financial hardship: The SFA's records demonstrate a signi?cant drop in meal
counts after the whole grain-rich products was offered.

Yes: (see attached)

 

Financial hardship: The SFA experienced a signi?cant cost increase when
procuring the whole grain-rich product(s).

 

Limited product availability: The SPA does not have to a compliant
whole grain-rich product(s) in the local market and would like to offer
enriched grain items(s) temporarily.

 

Preparation Harship: Unacceptable product quality: The whole grain-rich
product(s) offered by the SFA did not retain the desired texture or lost
palatibility during the typical holding time.

 

Yes: (see attached)

 

Hardship(s):

 

List the type of grain
product(s) to be exempted
(attach production record):

 

Poor student acceptability: The whoid grain-rich product(s) offered by the
SPA received signi?cant negative student/parent feedback or there was
increased plate waste of that menu item when the whole grain-rich
product(s) was offered multiple times and over a sustained period of time.

Yes: pasta (spaghetti and
macaroni), biscuits, and rice
(see attached)

 

Other hardship (please list):

 

 

 

List alternative product/types/brands that have been utilized:

 

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
pasta spaghetti Villa Frizzoni 8031-VIL
macaroni Barilla 1000440041
bread biscuits Pillsbury #06252
rice white rice producer 

 

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above,
that all records to support the information are available upon request by the State Agency.



 

 

 

 

Sigh?a?tuyf Director of School Nutrition Program Date
my f? 7-27 6-717
SCNmogram Coordtn/ator Date

Please complete this form, sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

KentuckyUnbridledSpirit.corn An Equal Opportunity Employer 
mm: 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2016-2017

I, ?ew Hill?) as the duly authorized representative of I, bob Egg I Name},
do hetebhattest that the aforementioned SFA and all schools under its jurisdiction de onstrate a ship in procuring

compiiant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National Schooi Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are acceptable to students.

 

The State Agency may approve an SFA's exemption request for specific products if the SPA can demonstrate hardshipis).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least haif of the grains offered weekiy are whole
grain-rich products. -

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich product(s) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in-the other hardship section. List the grain product(s) to be exempted.

*Reference: SP 33-2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
Justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant

drop in meal counts after the whole grain-rich produc?s) was 

offered.

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain~rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the locai market and
would like to offer enriched grain item(s) temporarily.

 

 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

- a
Wadi

 

Yes





List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

MW Mm

 

 

 

Other hardship (please list):

 

GEM an 

 

 

List alternative product types/brands that have been utilized:

 

Grain Item

Product Destription Manufacturer

Product Code

 

{bead

MJD

oasis"

 

?mj

we (5M

p?oii?m

53.911

 

 

 

 

 

 

Lam

 

BM

Page 2 of 3

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SFAs receiving the exemption
must ensure that at least half of the grain items offered weekly is whole grain~rich.

glow - Q'i?j?g

 

 

S?ig'nafu r?f Directdr'ol? Schools Date
I laud?
[Aye/7 
SGN7MC Program Coordinator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and employer.?

Page 3 of 3

Meal Report

Washington County to 06/09/2014) 3

 

 

 

 

 

 

 

 

 

 

 


Counts Tender Amounts
Student Status Reim. Non- Total Account Cash Check Charge Credit Total
Reim. Card
Breakfast
Adults 0 111 111 $121.95 $6.70 $0.00 $82.25 $0.00 $210.90
Employee 0 1015 1015 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Free 12256 89 12345 $28.35 $0.00 $0.00 $87.35 $0.00 . $115.70
HS PAID 2418 32 2450 $1,866.18 $1.00 $0.00 $1,317.84 $0.00 $3,185.00
Reduced 2314 34 2348 $373.83 $0.00 $0.00 $3 64.77 $0.00 $738.40
Breakfast Total: 16988 1281 18269 $2,390.09 $7.70 $0.00 $1,852.21 $0.00 $4,250.00
Grand Total: 16,988 1,281 18,269 $2,390.09 $7.70 $0.00 $1,852.21 $0.00 $4,250.00
Grand Total Average: 102 8 $14.40 $0.05 $0.00 $11.16 $0.00 $25.60
Number of Serving Days.
1 of1 v8.1.3.0 (M2140)

6/912016 12:33 PM

Request for Exemption for Whole Grain?Rich Requirements
School Year 2016-2017

as the duly authorized representative of A I ma! L13 Name],
do eh attest that the aforementioned SFA and all schools under its Jurisdiction de onstrate a her hip in procuring

comp iant whole grain-rich products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. In Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113-235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (SYs) 2014?2015, 2015-2016 and
2016-2017 to a school food authority (SFA) that demonstrates a hardship in procuring compliant whoie grain-rich
products that are acceptable to students.

 

The State Agency may approve an exemption request for specific products if the SFA can demonstrate 
The temporary exemptions are allowed for any type of grain productis), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013?2014 requirement of at least haif of the grains offered weekiy are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productisi-for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. if your hardship is
not listed, include in the other hardship section. List the grain productis) to be exempted.

*Reference: SP 33?2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meai counts after the whole grain-rich productls) was
offered. 

 

Financial hardship: The SFA experienced a significant cost
increase when procuring the whole grain-rich product(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

@455 ohm not Shale Fl
W6 club Gil/Adar.

 

EIELDEI

 

 

Unacceptable product quality: The whole grain-rich produc?s)
offered by the SPA did not retain the desired texture or lost
palatability during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record): -

 

Poor student acceptability: The whole grain-rich produc?s)
offered by the SPA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

SMWMEIS
regular Club

(limb/g :5 Salad

 

 

 

 

 

 

 

Other hardship (please list): 0X6 
List alternative product types/brands that have been utilized:
Grain item Product Description Manufacturer Product Code
i .
[Alma kiln/lac lmNicd I {9.0th Kerb! 6/ am 000 500(c-

 

1%th 

 

 

 

 

 

 

Page 2 of 3

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all records
to support the Information are available upon request by the State Agency, and that the SPAS receiving the exemption
ensure that at least half ofthe grain items offered weekly is whole grain-rich.

(Q
Mme Hm - 
Di?reb??r?f8chool? Be a


Date 

*Please complete this form, sign, and electronically submit to Sandy Wagner at sa ndra.wegner?educationkygov.

is an equal opportunity provider and employer.?

Page 3 of 3

Request for an Extension of Whole Grain Waiver Exemption

Memorandum SP33-2016 extends the ability, previously authorized by Section 751 of Public Law 113?234, for
school food authorities (SFAs) to request exemptions from the whole grain rich requirements in the National
School Lunch Program (NSLP) and School Breakfast Program (SBP) through the schooi year 2016-17. All
temporary flexibilities approved by a State agency under this superseded memorandum may continue under
the terms they were approved, through school year 2016-17, at the discretion of the State agency.

The State agency will consider hardship factors in allowing an extension for the listed whole grain-rich
product(s) for the 2016-17 school year. This extension will be in effect for the 2016-17 school veer and
the SFA is responsible for ensuring availability of whole drain rich products to meet the 100 percent of

grains offered must be whole grain rich requirement for the 2017-18 school vear.

List the grain products for which an extension is being requested and the continued hardship for consideration
as well as other products/brands tried in the proper columns below.

 

 

Grain Product for Continued Hardship (Financial Other Whole Grain

which an Extension of Hardship, Limited Product Products/Brands That Have

Waiver is requested. Availability, Poor Student Been Tried and Were not
Acceptability, Other) Accepted

 

 

PW Writ MM 9w

 

 

 

 

 

 

 

 

My signature indicates that i understand and'attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the exemption
must ensure that at least half of the grain items offered weekly are whole grain rich.

Q0 [Jared WW 

 

 

 

 

SignEtu? of Director of Schools District? Date
amen/4,
SCNIMC Program Coordinat?or Date

Please complete this form. sign, and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

 Prior Waiver Request for Whole Grain Rich Pasta SY 2014-2015

Instructions: Submit a completed waiver request form for each individual pasta product for which a
waiver is desired for SY 2014 2015.

Sponsor Name: WASHINGTON COUNTY SCHOOL DISTRICT

Name of Product a waiver is being requested for: 

Brand Name of product used: GFS macaroni

Recipe(s) in which the product is used: 

Other products tested: GFS WHOLE GRAIN MACARONI

Issues with products used and tested: TURNS TO HOLD GOOD

internal Use Only

 

Date Submitted: <3 rag?m

Date Approved: 3? i ?7
Approving Signature: Ma WW

Oiin?eW's ham saw issue; mi elm w! LUholx WUV
(AWOL hob? MM 

Don Parkinson

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Wayne D. Lewis
Interim Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

2 Hudson Hollow Suite Frankfort. Kentucky 40501
Phone: (502) 564-5625 - 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2018-19

I, 1% Emma HUGE) as the duly authorized representative of Name], do hereby attest

that ith?'Jai?orementioned SFA and all schools under its jurisdiction demonstrate a hards in procuring, preparing, or
serving compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products.

The interim ?nal rule from FNS-2017-0021, 7 CFR Parts 210, 215, 220 and 226 extends through school year 2018-19 the
menu ?exibilities giving the option to serve grain products which are not whole grain rich with an appropriate waiver.

The State Agency may approve an exemption request for speci?c products if the SPA can demonstrate hardship(s).
The temporary exemptions are allowed for any type of grain product(s], pasta, bread, brown rice, etc.) and for one or
more different products. SFAs granted an exemption must work with the State Agency to search for acceptable products,
and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whole grain-rich
products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the
2018-19 school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your
hardship is not listed, include in the other hardship section. List the grain product(s) to be exempted.


mimic is
KentuckyUnbridledSpirit.com UNBRIDLED 5mm. An Equal Opportunity Employer MIFID

Hardship(s]:

List the type of grain product(s) to
be exempted and attach
justi?cation documentation
(production records, receipts,
photos, etc.):

 

Financial hardship: The records demonstrate a significant drop in
meal counts after the whole grain-rich productts) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productls). 

 

Limited product availability: The SPA does not have access to a
compliant whole grain-rich product(s) in the local market and would
like to offer enriched grain item(s) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productls) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

RUNS

 

Hardship(s):

List the type of grain product(s) to
be exempted and attach
justi?cation (production records,
meal counts, students letters,
surveys, etc.):

 

Poor student acceptability: The whole grain-rich product(s) offered by
the SFA received signi?cant negative student/parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich product(s) was offered multiple times and over a sustained period
of time.

801 )5

 

 

Other hardship (please list):

 

 

List alternative product types] brands that have been utilized:

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
?3?5 ?n5 [ride/N (5?qu
[20} Rich?s DOG Roll at 

 

 

 

My Signature Indicates that I understand and attest to the accuracy or the intormatlon provnoed above. that all
records to support the information are available upon request by the State Agency. and that the exemption must
ensure that at least half of the grain items offered weekly are whole grain rich.

?Av/cm H1063 ?ll/15
Dat?e

Signatire quirectoI? ot? School Nutrition Program

Mat awe/P

SCNIMC Program Coordiry?ar Date

Please complete this form. sign, and electronically submit to Sandy Wagner at 

KentuckyUnbridledSpirit.corn Km UNBRIDLED (usm:ryh An Equal Opportunity Employer 

Request for Exemption for Whole Grain- Rich Requirements
School Year 2016- 2017

. I I
i, ;e%l?g I: Elm as the duly authorized representative of [a lag [3 heat a chg% Name],
do here attest that the aforementioned EPA and all schools under its Jurisdiction onstrate a he ship in procuring

compliant whole grain rich?products that are acceptable to students, and that the factors indicated in this document
pose a challenge in offering whole grain- -rich products in Section 751 of the Consolidated and Further Continuing
Appropriations Act, 2015 (Public Law 113- -235), Congress directed the Secretary of Agriculture to allow State Agencies
that administer the National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption
from the regulatory whole grain-rich requirement in the meal programs, in school years (8Y5) 2014-2015, 2015-2016 and
2016-2017 to a school food authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich
products that are accepta hie to students.

The State Agency may approve an exemption request for specific products if the SPA can demonstrate hardshipls).
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemptiOn must work with the State Agency to search for acceptable
products, and must comply with the SY 2013-2014 requirement of at least half of the grains offered weekly are whoie
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for SY
2016-2017. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is
not listed, include in the other hardship section. List the grain productls) to be exempted.

*Reference: SP 33~2016

Page 1 of 3

Yes

Hardship(s):

List the type of grain product(s)
to be exempted and attach
justi?cation (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain-rich product(s) was
offered. 

 

Financial hardship: The SFA experienced a significant'cest
increase when procuring the whole grain-rich prod uct(s).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich product(s) in the local market and
would like to offer enriched grain item(s) temporarily.

653 (\Dodies

 



 

 

Unacceptable product quality: The whole grain-rich product(s)
offered by the SFA did not retain the desired texture or lost
paiatability during the typical holding time.

 

 

Yes

Hardship(s):

List the type of grain product(s)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich product(s)
offered by the SFA received significant negative student/parent
feedback or there was increased plate waste of that menu item
when the whole grain-rich product(s) was offered multiple times
and over a sustained period of time.

 

 

 

Other hardship (please list):

We WW3 etched ?988?
bui- has diSc/?m?hnueci
?i?ime Hem.

 

?35 ?oodi?i

 

List alternative product types/ brands that have been utilized:

 

Grain item Product Description Manufacturer

Product Code

 

 

 

 

 

 

 

 

Page 2 of 3

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all records
to support the information are available upon request by the State Agency, and that the SPAS receiving the exemption
must nsu re that at least half of the grain Items offered weekly is whole grain?rich.

F1230) I 9 

Di Dat

 

    

 

 

KW/r/k?gy? 
sail/MC Program Cooggl?n?ator Date

*Please complete this form, sign, and electronically submit to Sandy Wagner at 

is an equal opportunity provider and ernployer.?

Page 3 of 3

 Prior Waiver Request for Whole Grain Rich Pasta 8? 2614-2015

Instructions: Submit a compieteri waiver request form for each individual pasta product for which a
waiver is desired for 2014 2015.

Sponsor Name: Russell County Board of EducationISchoOi Nutrition
Name of Product a Waiver is being requested for: {Eutr?e'lasagoa
Brand Name of product Food Service)

Reci'pe(s) in which the produtt is Comes iare?aSSerribiecianti ready to bake :zoon' deiivery
saving on and time {loo to (see attached spices)

Other products tested: Have searched for We preoaade product but none are availabie or on hid

issues with products used anti tested: in" the past, have made from scratch iasagna, hoWever due to
lunch scheduies, intensity and the'iizconsistency of amount-taste partitipation dropped.

Participation j?qeosedwiih the aromatic GFS yrociuct

 

internal Use Only

Date Submitted: "7 J7 520 L6
Date Approved: '1 <3 30 i if

Approving Slgnature: 5 

(7e7eiH)

@giw Vie/ma! con?rmim 
(lie c?iar

LoierLe mam moi/x pqyuo'is
Oww 0oVi3?dL ?nwwrih?

?id/96> Obit

 

Wagner, Sandra - Division of School and Community Nutrition

From: Wagner, Sandra Division of School and Community Nutrition

Sent: Wednesday, April 08, 2015 11:10 AM

To: Allen, Sandy

Cc: Bartenfield, Sue Nunn - Division of School and Community Nutrition
I Subject: W6 Waiver Exemption

Sandy,

We have looked at the whole grain rich requirement request for exemption that you submitted.

it is not the intent of this Waiver that an SFA stop serving whole grain rich products entirely. The intent is to
give time to find and serve acceptable whole grain rich products to their students. Even with an exemption of
some products, are required to offer at least 50% of their grain products as whole grain rich.

With the number of items that you have requested an exemption for we would need to know how you intend
to meet this requirement as well as how you intend to continue to try to find whole grain rich products your students
would accept.

it you would like to reapply for an exemption for a smaller number of products, please feel free to do so. We
would ask that you include invoices or production records from past years as well as the current year so that we may
compare the participation numbers.

Please feel free to contact me if you have any questions,

Thank you,

as Myron was an)

Program Coordinator

Kentucky Dept. of Education

Division of School and Community Nutriiton
(502) 564?5625 ext. 4946

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers,
employees, and applicants for employment on the bases of race, color, national origin, age, disability,
sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial
or parental status, sexual orientation, or if all or part of an individual?s income is derived from any
public assistance program, or protected genetic information in employment or in any program or
activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs
andfor employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program

Discrimination Complaint Form, found online at

?ling cust.html, or at any USDA of?ce, or call (866) 632-9992 to

request the form. You may also write a letter containing all of the information requested in the form.

Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture,

Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, DC. 202509410, by
fax (202) 690-7442 or email at proaram.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the
Federal Relay Service at (800) 8778339; or (800) 845?6136 (in Spanish).

USDA is an equal opportunity provider and employer

 

Steven Beahear Terry Holiiday, 
Governor Commissioner of Education

AND 
Qt: 

Capital Plaza Tower 6 588 inero Street a Frankfort, Kentucky 4060?
Phone: (502) 564-47?1?6 #5 Weeducationtygov

Request for Exemption for Whole Grain-Rich Requirements
School Years 2014-26315 and 2015-2016

i, Sandra L. Allen as the duly authorized representative of Wolfe County Board of Education, do hereby attest that the
aforementioned SFA and all schools under its jurisdiction demonstrate a hardship in procuring compliant whole grain-
rich products that are acceptable to students, and that the factors indicated in this document pose a challenge in
offering whole grain?rich products. in Section 751 of the Consolidated and Further Continuing Appropriations Act, 2015
(Public Law 113?235], Congress directed the Secretary of Agriculture to allow State Agencies that administer the
National School Lunch Program (NSLP) and School Breakfast Program (SBP) to grant an exemption from the regulatory
whole grain-rich requirement in the meal programs, in school years (5Y5) 2014-2015 and 2015-2016, to a school food
authority (SPA) that demonstrates a hardship in procuring compliant whole grain-rich products that are acceptable to
students.

 

The State Agency may approve an exemption request for specific products it the SPA can demonstrate hardshipls}.
The temporary exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one
or more different products. SFAs granted an exemption must work with the State Agency to search for acceptable
products, and must comply with the SY 2013~2014 requirement of at least half of the grains offered weekly are whole
grain-rich products.

The State Agency will consider hardship factors in allowing an exemption for the listed whole grain?rich productls} for
the remainder of 20144015 and SY 2015~2016. Place an in the appropriate column or columns (Yes) for each
hardship consideration. If your hardship is not listed, include in the other hardship section. List the grain productls} to be
exempted.

Kentucqunbn?dledSpirilcom An Equal Opportunity Employer MEFID

 

 

Yes

Hardship(s):

List the type of grain productls)
to be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 



Financial hardship: The records demonstrate a significant
drop in meal counts after the whole grain?rich productis} was
offered.

Biscuits, garlic toast, chicken
tenders, pasta, spaghetti, WJG rolls,
WIG mini corn dogs, Wis cookies, Wig
chicken nuggets, pancake wraps, 
hotdog and hamburger buns, WIS bread,
pizza crust

 

I Financial hardship:

 

The SFA experienced a significant cost
increase when procuring the whole grain-rich productis). -

Same as above

 

 

Limited product availability: The SFA does not have access to a
compliant whoie grain-rich productis) in the local market and
would like to offer enriched grain itemis) temporarily.

 

We are limited on distributors of bread
products and we oniy have 2 distributors for
other products. GFS and Uncle Charlie?s.

 

 

 

Unacceptable product quality: The whole grain?rich producds)
offered by the SFA did not retain the desired texture or test
palatability during the typical holding time.

 

Same as above.

 

 

Yes

 

Hardship(s):

List the type of grain productis)
to be exempted (attach
production record):

 

Poor student acceptability: The whole grain-rich producds}
offered by the SFA received significant negative studentIparent
feedback or there was increased plate waste of that menu item
when the whole grain-rich productls) was offered multiple times
and over a sustained period of time.

W23 biscuits, WJG gariic toast, W16 wicker
tenders, pasta, spaghetti, W16 rolls,
WIG mini corn dogs, cookies, WIS
chicken nuggets, WIS pancake wraps, WIG
hotdog and hamburger buns, bread,
WIG pizza crust.

 

 

 

Other hardship (piease list): 0

 

Our students does not like the wig
products, and i know that some of our
students goes hungry because they just
don?t iike the food. Our county is very poor
and for a majority of our students, the
hreakiast?unch meal is ali they get. Kids get
in more trouble because they are hungry.

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Rolls Wheat Rolls 112401; 233140; 631902
Biscuits Whole Grain Biscuits 555 237390; 631902: 515110
Garlic Toast Whole Grain Garlic Toast 2739362; Limited on brands we
can order.

 

 

 

 

 

Page 2 of 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Grain item Product Description Manufacturer Product Code
Pancake Wraps Wheat pancake Wraps GFS 4927182; 497202
Spaghetti/Macaroni Wheat pasta Dakota Growers, GFS 232471; 2214-60
Chicken Nuggets Chicken Nuggets - Tyson 501851, limited
Chicken Strips/Tenders WIG Chicken Stripszender Tyson 235211; 533830;

Com Dogs Com Dogs State Fair 620220; 497360 
Cookies Cookies Deiicious Essentials 243371; 243400;
Hamburger/Hotdog Buns Hamburger/Rotting buns Hamilton 0003447; 0004264? limited
Loaf Bread WIG Loaf Bread Hamilton 

Sub Buns WIG Sub Buns Hamilton 0004256? limited

 

 

 

 

 

 

 

 

My signature indicates that i understand and attest to the accuracy of the information provided above, that all
records to support the information are available upon request by the State Agency, and that the SFAs receiving the
exemption must ensure that at least half of the grain items offered weekly is whole grain-rich.

Q??mdbm 0f aim 61/7ga20/5

 

 

SigiEature of Director oi Schools Date

i

it) ml. at, . ?jgsw elk/Mas
Appre?pved Program?l?anager Date

*Please complete this form, Sign, and eiectrooicaily submit to Sue Barten?eld at 

is an equal opportunity provider and empioyer.?

Page 3 of st-

 

Hal Heiner

Secretary

Education and

Workforce Development Cabinet

Matthew G. Bevin
Governor

 

Stephen L. Pruitt. 
Commissioner of Education

KENTUCKY DEPARTMENT OF EDUCATION

Capital Plaza Tower . 500 Mere Street 0 Frankfort, Kentucky 40601
Phone: (502) 564-3141 0 

Request for Exemption for Whole Grain-Rich Requirements
School Year 2017-18

. Woodie? Counly Schools
I, courtney as the duly authorizad representative of Name], do hereby attest

that the aforementioned EPA and all schools under its jurisdiction demonstrate a hardship in procuring, preparing, or
sewing compliant whole grain-rich products that are accepted by students, and that the factors indicated in this document
pose a challenge in offering whole grain-rich products. Section 747 of the Appropriations Act provides ?exibilities related to
whole grains, sodium and ?avored milk for school year (SY) 2017-18.

 

may approve an exemption request for speci?c products if the SPA can demonstrate hardshipts). The
exemptions are allowed for any type of grain productls), pasta, bread, brown rice, etc.) and for one or more different
products. SFAs granted an exemption must comply with the 2013-2014) requirement of at least half of the grains
offered weekly are whole grain-rich products.

will consider hardship factors in allowing an exemption for the listed whole grain-rich productls) for the 2017;18
school year. Place an in the appropriate column or columns (Yes) for each hardship consideration. If your hardship is not
listed, include in the other hardship section. List the grain productls) to be exempted.

Automatic extensions from SY 2016-17:

All exemptions approved by the Division of School and Community Nutrition, KDE, under SP 33-2016, Exemption Notice:
Request for Exemptions from the School Meals' Whole Grain-Rice Requirements for School Year 2016-17, April 29, 2016,
may continue under the terms by which they were approved, through 2017-18.

*Reference: SP 32-2017
SP 33-2016

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KentuckyUnbridledSpintcom spmy An Equal Opportunity Employer 

Hardshipls):

List the type of grain productis] to
be exempted and attach
justification (pictures, receipts,
etc. for documentation):

 

Financial hardship: The records demonstrate a signi?cant drop in
meal counts after the whole grain?rich product(s) was offered.

 

Financial hardship: The SFA experienced a signi?cant cost increase
when procuring the whole grain-rich productis).

 

Limited product availability: The SFA does not have access to a
compliant whole grain-rich productls) in the local market and would
like to offer enriched grain itemls) temporarily.

 

 

Preparation Hardship: Unacceptable product quality: The whole
grain-rich productts) offered by the SPA did not retain the desired
texture or lost palatability during the typical holding time.

 

Pasta, Biscuit. Hamburger
Bun, Tortilla,

 

Hardship(s):

List the type of grain productls) to
be exempted (attach production
record):

 

Poor student acceptability: The whole grain-rich productls) offered by
the SPA received significant negative student! parent feedback or there
was increased plate waste of that menu item when the whole grain-
rich productis) was offered multiple times and over a sustained period
of time.

Pasta, Biscuit, Hamburger
Bun. Tortilla.

 

 

Other hardship (please list]:

 

 

List alternative product types/brands that have been utilized:

 

 

 

 

 

 

 

 

Grain Item Product Description Manufacturer Product Code
Biscuit Whole grain 2.51 oz biscuit Pillsbury 269210
Pasta 51% whole grain macaroni Dakota Growers 229941

Tortilla Whole grain 6 in tortilla Azteca 523610

 

 

 

 

My signature indicates that I understand and attest to the accuracy of the information provided above, that all

reg-Us port Mthz?ation are available upon request by the State Agency.
1 2 0 

 

 

JSignatur?Di?tcr of School Nutrition Program Date
?(La/1 
Program Cyfdinator Date

Please complete this form. sign. and electronically submit to Sandy Wagner at Sandra.wagner@education.ky.gov

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KsntuckyUnbridledSpiriLcorn eugmmg ?Rwy An Equal Opportunity Employer