Student Free/Reduced Lunch School verification form
Student Name
*
First Name
Middle Name
Last Name
Student School Name
*
Leave Blank if you are Not a High School Student
What Government Benefit does the student receive?
*
Please Select
School FREE and REDUCED Lunch
Student Date of Birth
*
-
Month
-
Day
Year
Date
Parent Name
*
First Name
Middle Name
Last Name
Parent Date of Birth
*
-
Month
-
Day
Year
Date
Parent Social ( Last 4 # only)
*
Address
*
Street Address
Apt. Number
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Parent Email
example@example.com
Take a Photo of your Driver License.
File Upload
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I certify that I am the Parent/Guardian of the child that receives the Free/Reduced price School Lunch.
Signature
*
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