School Nutrition Program Income Eligibility Form

1

Do you have at least one child enrolled in a school who lives in your household?* This field is required.

YESNO

2

How many members are there in your entire household?Including yourself, the child or children you're seeking no cost or reduced-price meals for, and all other members living in your home.

3

Does your household earn less than $23,606?

YESNO

4

Does your household earn less than $31,894?

YESNO

5

Does your household earn less than $40,182?

YESNO

6

Does your household earn less than $48,470?

YESNO

7

Does your household earn less than $56,758?

YESNO

8

Does your household earn less than $65,046?

YESNO

9

Does your household earn less than $73,334?

YESNO

10

Does your household earn less than $81,622?

YESNO

11

Does your household earn less than $86,102?

YESNO

12

Does your household earn less than $90,582?

YESNO

13

Does your household earn less than $95,062?

YESNO

14

Does your household earn less than $99,542?

YESNO

15

You may qualify for no cost or reduced-price meals! Eligible families should contact their local school to submit an application. Would you like to see other help options that may be available?

YESNO

16

You may not qualify for the programs administered by the Food & Nutrition Division. However, there may still be help available.

Check with Texas Health and Human Services to determine if you qualify for SNAP, TANF, Medicaid, CHIP or other programs.
Check with Texas WIC to determine if you are eligible for WIC benefits.

In addition, some schools operate their own programs, separate from TDA and USDA, using their own qualifications. Be sure to check with your school to determine what programs they participate in and/or operate.

17

There may be other help available.

Check with Texas Health and Human Services to determine if you qualify for SNAP, TANF, Medicaid, CHIP or other programs.
Check with Texas WIC to determine if you are eligible for WIC benefits.