Free And Reduced Price Meals Application

2023-2024 Free and Reduced Price Meals


Please read through the linked document in order to view the full application before filling this form out and signing the form,

Complete one application per household.

Referenced documents: Free and Reduced Lunch PDF

Contact Information of person filling out the form

 I would like to receive text notifications.

STEP 1: List ALL children, infants, and students up to and including grade 12. Attach another sheet of paper if you need space for more names.

List ALL children in the household. Do not forget to list infants, children attending other schools, children not in school, and children not applying for benefits. This includes children not related to you in your household.

CHILD #1

Child # 1 - Check all that apply to child (skip if "no")

CHILD #2

Child # 2 - Check all that apply to child (skip if "no")

CHILD #3

Child # 3 - Check all that apply to child (skip if "no")

CHILD #4

Child # 4 - Check all that apply to child (skip if "no")

CHILD #5

Child #5 - Check all that apply to child (skip if "no")

STEP 2: Do any Household Members (including you) currently participate in one or more of the following eligible assistance programs: Snap TANF, or FDPIR? If NO > Go to Step 3.

If yes; check all that apply.

STEP 3: List ALL household members and income for each member (before taxes and deductions)

A. All Adult Household Members (Anyone who is living with you and shares income and expenses, even if not related, including you.) List all Adult Household Members not listed in STEP 1 (including yourself ) even if they do not receive income.

For each Household Member listed, if they receive income, report total gross income (before taxes and deductions) for each source in whole dollars (no cents) only. If they do not receive income from any source, write ‘0’.

If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report.

“I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, school officials my verify (confirm) the information.

I am aware that if I purposely give false information, my children may lose meal benefts, and I may be prosecuted under applicable State and Federal laws.”

charts for STEP 3

If you are unsure of what to put in STEP 3 - Report Income for ALL Household Members, here is the back of the page so you can reference the charts.

Our highest endeavor must be to develop free human beings who are able, of themselves, to impart purpose and direction to their lives.

—Rudolf Steiner