2024-2025 Household Application for Free and Reduced Price School Meals

Household Application for Free and Reduced Price School Meals
STEP 1
List ALL Household Members who are infants, children, and students up to and including grade 12 (if more spaces are required for additional names, attach another sheet of paper)
Definition of Household Member: “Anyone who is living with you and shares income and expenses, even if not related."

Children in Foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals. Read How to Apply for Free and Reduced Price School Meals for more information.

Explanation that WIC participants may be eligible for free and reduced-price meals.

Foster Child Statement – “Foster children will free benefits regardless of the child’s personal income or the income of the household.” If you have foster children living with you and wish to apply for such meals for them, please contact us.” In lieu of this statement, the school food authority (SFA) may include on the form the instructions on how to apply for a foster child.”
Child's Name*

First NameMILast Name
Grade*
Student?*

YesNo
Check All That Apply

Foster ChildMigrantRunawayHomeless

STEP 2
Do any Household Members(including you)currently participate in one or more of the following assistance programs: SNAP, TANF, or FDPIR?*

NoYes - Provide case number below then go to Step 4 (Do not complete STEP 3)
Case Number
Provide only one case number in this space

STEP 4 - Contact information and adult signature
“I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given connection with the receipt of Federal funds, and that school officials may verify (confirm) the information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws."
Name of Adult Signing This Form*

First NameLast Name
Signature of adult*

Clear
Today’s date

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone (optional)
Please enter a valid phone number.
Email (optional)
example@example.com

OPTIONAL - Children's Racial and Ethnic Identities
We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.
Ethnicity (check one)

Hispanic or LatinoNot Hispanic or Latino
Race (check one or more)

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite

Household Application for Free and Reduced Price School Meals