FRAM Verification Form

FRAM Verification Form
Our school is participating in the Community Eligibility Provision (CEP) under the National School Lunch Program. The CEP provision is available to schools with a high percentage of economically disadvantaged students. Under CEP all students receive a breakfast/lunch at no charge for the entire school year. However, to determine eligibility to receive additional benefits for your child(ren) you will need to complete a household and income form.
1. DO I NEED TO FILL OUT A FORM FOR EACH CHILD? No. Use one Household and Income Form for all students in your household. We cannot use a form that is incomplete, so be sure to fill out all required information. Return the completed form to school.
2. MY CHILD(REN) ALREADY RECEIVE MEALS AT NO CHARGE AT SCHOOL. WHY SHOULD I COMPLETE THIS FORM AS WELL? Many state and federal programs use socioeconomic status (that is, household and income information) to determine eligibility for their programs. In addition, the primary state funding calculation uses socioeconomic status. By completing this form your school is able to determine your child(ren)’s eligibility for additional programs. Regardless, your child(ren) will still receive meals at no charge.
3. WHO SHOULD I INCLUDE AS MEMBERS OF MY HOUSEHOLD? You must include all people living in your household, related or not (such as grandparents, other relatives, or friends) who share income and expenses. You must include yourself and all children living with you. If you live with other people who are economically independent (for example, people who you do not support, who do not share income with you or your children, and who pay a pro-rated share of expenses), do not include them.
4. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income.
5. WE ARE IN THE MILITARY. DO WE INCLUDE OUR HOUSING ALLOWANCE AS INCOME? If you get an off-base housing allowance, it must be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income.
6. MY SPOUSE IS DEPLOYED TO A COMBAT ZONE. IS HIS/HER COMBAT PAY COUNTED AS INCOME? No, if the combat pay is received in addition to his/her basic pay because of his/her deployment and it wasn’t received before s/he was deployed, combat pay is not counted as income. Contact your school for more information.
If you have other questions or need help, call 502-845-4788.

Sincerely,

Eminence Independent Schools
Jenny Smithson
FRAM COORDINATOR
INSTRUCTIONS FOR APPLYING

Part 1: All Household Members (a household member is any child or adult living with you): All applicants should complete this part. List the name of each household member, the name of the school each child attends, and the child’s grade. If the child is a foster child, check the box for foster child. If a household member has no income, check the box for no income. All household members, including foster children, should be included here. If you need additional space, attach a separate piece of paper.

If your child is homeless, a migrant or a runaway, follow these instructions.

Part 2: Check the appropriate category and call 502-845-4788.
Part 3: Skip this part.
Part 4: Sign the form.

If you have foster child(ren) only, follow these instructions. You do not need to fill out a separate form for each foster child in your household. (If there are both foster children and non-foster children in your household, follow the instructions below for All Other Households).

If all children in the household are marked as foster children in Part 1:

Part 2: Skip this part.
Part 3: Skip this part.
Part 4: Sign the form.

ALL OTHER HOUSEHOLDS, including WIC households, households with non-foster children and households with both foster children and non-foster children, follow these instructions:

Part 2: Skip this part.
Part 3: Follow these instructions to report total household income from this month or last month.
- Section 1–Name: List all household members who have income.
- Section 2 –Gross Income and How Often It Was Received: List the income for each household member. Check the box to tell us how often the person receives the income—weekly, every other week, twice a month, or monthly.
  - Earnings from work: List the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. Net income should only be reported for self-owned business, farm, or rental income.
  - Welfare, Child Support, Alimony: List the amount each person receives, and check the box to tell us how often.
  - Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits. List the amount each person receives, and check the box to tell us how often they receive it.
  - All Other Income: List Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income received weekly, every other week, twice a month, or monthly. Do not include income from KTAP, SNAP, WIC, federal education benefits and foster payments received by your family from the placing agency.
    If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.
Part 4: An adult household member must sign the form. Please include your address and phone number in the event the FRAM Coordinator has a question about your information.
HOUSEHOLD AND INCOME FORM
2025-2026

EMINENCE INDEPENDENT SCHOOLS is participating in the Community Eligibility Provision (CEP) under the National School Lunch Program. Under CEP, all children in the school will receive a breakfast/lunch at no charge regardless of income or completion of this form. However, to determine your child(ren)’s eligibility for various additional state and federal program benefits, please complete, sign and return to EMINENCE INDEPENDENT SCHOOLS.

PART 1. ALL HOUSEHOLD MEMBERS

ALL HOUSEHOLD MEMBERS

	Names of all people living in your household (First, Middle Initial, Last)	School the child attends, or indicate “NA” if household member is not in school	Grade Level	Check if a foster child (legal responsibility of the state welfare agency or court). If all children listed below are foster children, skip to Part 4 to sign this form.
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2
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8

PART 2. HOMELESS, MIGRANT, RUNAWAY STATUS
If any child you are applying for is homeless, migrant, or a runaway, check the appropriate box and call 502-845-4788.

HOMELESS, MIGRANT, RUNAWAY STATUS

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HOMELESS
MIGRANT
RUNAWAY

PART 3. TOTAL HOUSEHOLD GROSS INCOME (before deductions).
List all income on the same line as the person who receives it. Check the box for how often it is received. Record each income only once. If you provided a case number in Part 2, you do not need to provide income information. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report.
DECLINE TO PROVIDE INCOME – Check this box if you don’t wish to provide your income information; your SES status will automatically be “Paid”.

List only household members with income, including any students in the home who have income

	Full Name	Earnings from work before deductions ($ dollar amount)	Frequency	Public assistance, child support, alimony ($ dollar amount)	Frequency	Pensions, retirement, Social Security, SSI, VA benefits, All Other Income ($ dollar amount)	Frequency
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PART 4. SIGNATURE (ADULT HOUSEHOLD MEMBER MUST SIGN)
Signature*

Clear
Name

First NameLast Name
Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Non Discrimination Statement: In accordance with Federal Law and U.S. Department of Education policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, gender identity, age, or disability. To file a complaint of discrimination, write U.S. Department of Education, Office for Civil Rights, The Wanamaker Building, 100 Penn Square East, Suite 515, Philadelphia, PA 19107-3323 or call (215) 656-8541 (Voice). Individuals who are hearing impaired or have speech disabilities may contact U.S. DOE through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). The U.S. Department of Education is an equal opportunity provider and employer.

Privacy Notice: The Kentucky Department of Education is requiring schools to collect the information on this form. You do not have to give this information, but if you do not, we cannot determine your child’s eligibility for additional benefits under state and federal programs. We will hold the information you provide us as private and confidential to the extent required by law. However, we will share your socioeconomic status with various state and federal programs to help them evaluate, fund, or determine benefits for their programs, with auditors for program reviews, and with law enforcement officials to help them look into violations of program rules. Regardless, all students enrolled in a Community Eligibility Provision school will receive meals at no charge.

HOUSEHOLD CHECKLIST*

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Have you included all your children as household members?
For each household member receiving income, is the frequency checkbox checked?
Have you signed the form?

After clicking Submit, please return to Infinite Campus to complete the school enrollment form. Completion of this FRAM Verification Form is not a complete school enrollment.
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FRAM Verification Form

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