Do not complete this form if you are Directly Certified to receive free meals.
For your school to receive specific state and federal benefits and funding, you must fill out this form.
There are number* people in my household, including all children and adults. The total annual income for all people in the household before any deductions for taxes, insurance, medical expenses, child support, etc. is $* per year.
I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will receive federal and state funding based on the information provided. I understand that school officials may verify (check) the information.