Male/Female Separation Exception Request

Texas Department of Agriculture | Male/Female Separation Exception Request Form | February 19, 2025.

This form is intended to be used by a contracting entity (CE) to request an exception to the prohibition on separating males and females during meal service. TDA will grant an exception to the prohibition on male/female separated meal service if the CE meets the circumstances outlined by USDA (SP 31-2015, CACFP 12-2015, and SFSP 14-2015, March 2015).

This form must be completed and signed by a current authorized representative for the CE.

To request an exception to the male/female separation prohibition, take the following actions.

Complete the Male/Female Separation Request Form. This form is a web-based form that is accessed in the Application Module, Download forms page in TX-UNPS.
Ensure that the request form is signed (electronic signature) by a duly authorized representative of the CE for the current program year and attest to the information provided in the request form.
Submit the request to the Texas Department of Agriculture (TDA) by using the submit button located at the end of this form.
Retain all documentation related to an approved exception for the period of time the circumstance, as described in Part II of this form, exist plus the required years of retention for the program.

Private Schools, Other Nonprofit Organizations, and Residential Child Care Institutions	=	Period of Time the Circumstance Exists As Described in an Approved Exception	+	3 years
Public Schools and Charter School	=	Period of Time the Circumstance Exists As Described in an Approved Exception	+	5 years

Questions about this form may be submitted to the Texas Department of Agriculture (TDA) by email to snpwaivers@texasagriculture.gov. Male/Female Separation should be recorded in the email subject line.

* Indicates required fields.

Part 1: CE Information

Provide the information requested in the spaces below.

CE Name*

CE Identification Number (CE ID)*

Please enter 5-digit number used in TX-UNPS

Site Name*

Site Identification Number (Site ID)*

Please enter 4-digit Site ID

Part 2: Circumstances

For each of the following statements click Yes if the circumstance applies and provide a brief statement about why separation of males and females is necessary. Click No if the circumstance does not apply. *

1 Meal service at religious institutions operating under the dictates (laws or decrees) of the religion with which they are affiliated (i.e., religious doctrines that prohibit mixing or co-mingling different sexes)*

YesNo

Please include a brief statement describing religious dictates that require male/female separation:

2 Meal service at juvenile correctional facilities where combining the members of opposite sex would present a potential safety risk (i.e., juvenile detention center where males and females are separated for safety)*

YesNo

Please include a brief statement describing why circumstances indicate a potential safety risk:

3 Meal service at facilities that fully separate by males and females as part of their normal operations (summer camps or conferences where separation of males and females is essential to the program's design, i.e., conferences or summer programs with only male or female attendees)*

YesNo

Please include a brief statement describing circumstances where male/female separation is part of normal CE operations:

Please include a brief statement describing the other circumstances which dictate the need for male/female separation:

Part 3: Attestation Statement

Check the following statement as true.

Required *

I certify that the information provided on this form is true and accurate.

Entering a name in the boxes below serves as an electronic signature.

Electronic signature (name of person attesting to the information in this form):*

First NameLast Name

Title of Authorized Representative:*

CE Phone Number*

E-mail Address for Confirmation:*

Alternate Email Address

Form Completion Date:*

MonthDayYear

Select Print Form to print a copy of the form.
Select Submit to send form to TDA.
- It may take a few minutes for the form to submit depending on your connection speed.
- Please click Submit only once.
You will receive a confirmation email message with a copy of the completed form sent to the email address provided in the contact section after the submission is complete.

Reason(s) request has been denied:

CEID and/or CE Name does not match Tx-UNPSAuthorized Representative was not found in Tx-UNPSYou selected "No" to all 3 of the questions above (at least one question has to be marked yes in order to qualify for this waiver.