2025-2026 Application for Educational Benefits

2025-2026 Application for Educational Benefits

Free & Reduced Price School Meals
Parent Name

First NameLast Name
Parent Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email
example@example.com
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Do Any Household Members (including you) currently participate in one or more of the following assistance programs: SNAP, MFIP or FDPIR? Medical assistance does not qualify.
Enter SNAP, MFIP or FDPIR Case Number (between 4-9 digits, do not report EBT card number)

Last Four Digits of Social Security Number (SSN) of an Adult Household Member:
xxx-xx-____
Total Number of All Household Members (Children + Adults)

Child Income: Sometimes children in the household earn or receive income, such as from a part time job or SSI. Please include the TOTAL income received by all children in the household. Do not include income received by adults.

Rows	Total Income $	Payment Frequency
Household Child Income

How many adult members are in your household? Please include children who are temporarily away at school or in college.
Adult 1

First NameLast Name

Adult 2

First NameLast Name

Adult 3

First NameLast Name

Adult 4

First NameLast Name

Signature
Name

First NameLast Name
Should be Empty: