Breakfast Template – Seven Days

Minimum Per Day / Notes
Milk
(fluid milk: whole milk, low fat, fat free) / 1 cup / Served as a beverage or on cereal or used in part for each purpose.
o  Recommend multiple choices daily to increase participation.
o  1% fat content or less is recommended for age 2 and older.
Fruits
Vegetables
100% Juice / ½ cup / From a single source or from a combination of two or more smaller portions with 1/8 cup being the smallest creditable amount. ¼ cup dried fruit counts at ½ cup fruit.
Meat/Meat Alternate / N/A / (Optional) Equivalent quantity of any combination of:
o  1 oz. lean meat/poultry/fish
o  1 oz. cheese
o  ½ large egg
o  ¼ cup cooked dry beans or peas
o  2 tablespoons peanut butter or other nut butters
o  4 oz. or ½ cup yogurt
Grains / 1 oz. eq. / Creditable grains and breads must be whole grain-rich or enriched, or made from whole grain or enriched flour or meal. One serving may include:
o  1 slice bread
o  ¾ cup or 1 oz. cold dry cereal
o  ½ cup cooked cereal, cereal gains, cooked pasta or noodle products

INSTRUCTIONS:

Your menu template will be reviewed by a Registered Dietitian for adequate components and acceptable products.

Please send one of the following forms of documentation for each item that consists of 2 or more ingredients:

·  Recipe that includes the ingredients and ingredient amounts by weight and volume

·  USDA-Authorized CN Label (provide a digital photo or photocopy of the CN Label and the nutrition facts with ingredient list), or

·  Product formulation statement on manufacturer’s letterhead that demonstrates how the processed product contributes to the meal pattern requirement and digital photo or photocopy of the product’s nutrition facts with ingredient list.


Agreement # / Sponsor / Contact Name
Components / Day 1 / Day 2 / Day 3 / Day 4 / Day 5 / Day 6 / Day 7
Grains
Minimum:
1 oz. per day / Item
Portion
Contribution (oz. eq.)
2nd Item
(If planned)
Portion
Contribution (oz. eq.)
Meat/Meat Alternates
(optional) / Item
Portion
Contribution (oz. eq.)
2nd Item
(If planned)
Portion
Contribution (oz. eq.)
Fruits Vegetables
100% Juice
Minimum:
½ cup per day / Item
Portion in cups
2nd Item
(If planned)
Portion in cups
Other Foods/ Condiments / Item
Portion size
White / Chocolate / Strawberry / Other (specify)
Daily
Milk / Fat Content
Fluid oz.

Abbreviations: oz. eq. = ounce equivalent, WGR = whole grain-rich, M/MA = meat/meat alternate FDACS Revised 8/2015