SY25 Free and Reduced-Price School Meal Application

Free & Reduced-Price School Meal Application for 2024-2025

For each household, complete, sign and return the application to the school.
Step 1: STUDENT INFORMATION

List all students living in the household*

	Student Last Name	Student First Name	School	Foster Child	Homeless/Migrant
1
2
3
4

Step 2: BENEFITS
Do any members of your household receive SNAP, TANF, or FDPIR assistance?*

YesNo
If no: Complete step 3.

If yes: Provide the case # and name of person receiving benefits. Do not complete step 3.
Name
SNAP or TANF Number
Step 3: INCOME
Not required.

SIGNATURE: An adult household member must sign the application and list the last 4 digits of their social security number before it can be approved.
Signature of Adult*

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Last 4 Digits of Social Security #
I do not have a Social Security #
Printed Name*
Email*
example@example.com
Home Phone*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date

MonthDayYear
Date
Should be Empty: