Improving School Meal Program Accuracy through Pre-Ordering and Grab and Go Systems - Students (Individuals and Households)

Generic Clearance to Conduct Formative Research or Development of Nutrition Education and Promotion Materials and Related Tools and Grants for FNS Population Groups

Appendix E.1 - Pre-ordering App 5.3 Paper

Improving School Meal Program Accuracy through Pre-Ordering and Grab and Go Systems - Students (Individuals and Households)

OMB: 0584-0524

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Appendix E.1 – Pre-ordering App Examples - Paper

This attachment provides possible examples of the paper pre-ordering apps.

Exhibit 1: This is a paper pre-ordering app template. This first app allows students to choose from the full-range of items available in the cafeteria.

Exhibit 2: Also a paper-based pre-ordering app, this second example gives students a range of meal options but does not include a la carte items that are available in the cafeteria. This example also encourages students to select a complete meal by suggesting students select three components from the menu options.

Exhibit 3: This is the last of the paper-based pre-ordering apps and is the most restrictive pre-ordering option, whereby students select from a small number of complete meals and do not select individual components.





Exhibit 1


Example of a possible, generic format for a school meal pre-ordering form – Version 1 (full menu)


Student’s Name ________________________________________________________________

Student ID ________________________________________________________________


Lunch (please circle the items you want for your lunch)


Cold Entrées: Salad A Salad B Salad C

Deli Sandwich A Deli Sandwich B Deli Sandwich C



Hot Entrées: Grilled entrée A Grilled entrée B Vegetarian entrée

Baked entrée A Baked entrée B Pasta entrée



Sides: Fresh fruit A Fresh fruit B Fruit mixture A

Vegetable A Vegetable B Vegetable C


Drinks: Fat-free milk Flavored fat-free milk

Reduced-fat milk Flavored reduced-fat milk

100% juice 100% juice fruit smoothie

A la carte: Granola String Cheese Yogurt

Whole grain cookie Baked chips Popcorn

100% juice slushies muffins Reduced-sugar fruit snacks








According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required for a student to select his or her meal is estimated to average one (1) minute. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-0524). Do not return the completed form to this address.


Exhibit 2

Example of a possible, generic format for a school meal pre-ordering form – Version 2 (limited menu)


Student’s Name ________________________________________________________________

Student ID ________________________________________________________________


Lunch (please circle at least one entrée, one side, and one drink)


Cold Entrées: Salad A Salad B Salad C

Deli Sandwich A Deli Sandwich B Deli Sandwich C



Hot Entrées: Grilled entrée A Grilled entrée B Vegetarian entrée

Baked entrée A Baked entrée B Pasta entrée



Sides: Fresh fruit A Fresh fruit B Fruit mixture A

Vegetable A Vegetable B Vegetable C


Drinks: Fat-free milk Flavored fat-free milk

Reduced-fat milk Flavored reduced-fat milk

100% juice 100% juice fruit smoothie










According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required for a student to select his or her meal is estimated to average one (1) minute. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-0524). Do not return the completed form to this address.



Exhibit 3


Example of a possible, generic format for a school meal pre-ordering form – Version 3 (reimbursable meals only)


Student’s Name ________________________________________________________________

Student ID ________________________________________________________________


Lunch (please circle the meal you’ve selected)


Meal 1 Salad B Fresh fruit A Flavored reduced-fat milk

Meal 2 Deli Sandwich A Vegetable C Fat-free milk

Meal 3 Vegetarian entrée Fresh fruit B 100% juice fruit smoothie


Meal 4 Grilled entrée A Vegetable B Reduced-fat milk

Meal 5 Pasta entrée Fresh fruit B Flavored fat-free milk



















According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required for a student to select his or her meal is estimated to average one (1) minute. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-0524). Do not return the completed form to this address.

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