• 2026-2027 Household Application for Free and Reduced Price School Meals

  • Complete one application per household. Please use a pen (not a pencil).
  • Prescribed by State Board of Accounts School Form No. 521/2026
  • Apply Online:

  • Return to: Switzerland County Community School Corporation

  • Address: 1040 W. Main Street, Vevay IN 47043

  • Instructions for each step including income examples can be found on the Parent Letter and Instructions page.

  • STEP 1 List ALL children, infants, and students up to and including grade 12. Attach another sheet of paper if you need space for more names.

  • List ALL children in the household. Do not forget to list infants, childrenattending other schools, children not in school, and children not applying for benefits. This includes children not related to you in your household.
  • Rows
  • Check all that apply
  • Does this Child Live with a parent or caretaker relative?*
  • Is there second child in the household?*
  • Rows
  • Check all that apply
  • Does this Child Live with a parent or caretaker relative?*
  • Is there a third child in the household?*
  • Rows
  • Check all that apply
  • Does this Child Live with a parent or caretaker relative?*
  • Is there a fourth child in the household?*
  • Rows
  • Check all that apply
  • Does this Child Live with a parent or caretaker relative?*

  • STEP 2 Do any household members (including you) participate in: SNAP or TANF?

  • Do any household members (including you) participate in: SNAP or TANF?*
  • Go to STEP 3.
  • Write case number here and proceed to STEP 4.
  • Write only 10-digit case number in this space.

  • STEP 3 List ALL household members and income for each member (before taxes and deductions)

  • A. All Adult Household Members (Anyone who is living with you and shares income and expenses, even if not related, including you.)
  • List all Adult Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they receive income, report total gross income (before taxes and deductions) for each source in whole dollars (no cents) only. If you enter '0' or leave any fields blank, you are certifying (promising) that there is no income to report.
  • How often are earnings received from first adult household member?*
  • How often are additional earnings received?
  • How often are additional earnings received?
  • Is there a second adult member in the household?*
  • How often are earnings received from second adult household member?
  • How often are additional earnings received?
  • How often are additional earnings received?
  • Is there a third adult member in the household?*
  • How often are earnings received from second third household member?
  • How often are additional earnings received?
  • 3 How often are additional earnings received?
  • Is there a fourth adult member in the household?
  • How often are earnings received from second fourth household member?
  • How often are additional earnings received?
  • How often are additional earnings received?
  • B. Child Income
  • Sometimes children in the household earn or receive income. Include the TOTAL income (before taxes and deductions) received by ALL children listed in STEP 1 here.
  • How often received?

  • STEP 4 Contact information and adult signature. RETURN COMPLETED FORM TO YOUR CHILD'S SCHOOL:

  • "I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in 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."
  • Today's Date:*
     - -
  • Format: (000) 000-0000.
  • Optional Children's ethnic and racial identities. This information is kept confidential and may be protected by the Privacy Act of 1974. 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.
  • Return this completed form to your child's school. *Do not mail, fax, or email completed applications to the U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights.

  • DO NOT FILL OUT For school use only.

  • Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice a Month x 24, Monthly x 12. Do not annualize income to determine eligibility unless more than one income frequency is listed.

  • For use at verification

  • Use of Information Statement

  • The Richard B. Russell National School Lunch Act requires that we use information from this application to see who qualifies for free or reduced price meals. We can only approve complete forms. We may share your eligibility information with education, health, and nutrition programs to help them deliver program benefits to your household. Inspectors and law enforcement may also use your information to make sure that program rules are met. Please be sure to provide the last four numbers of the Social Security number of the adult household member who signs the application. If the adult does not have one, 'Check if no Social Security Number'. Applications for a foster child do not need to list a Social Security number. Applications for children in households receiving Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) or Food Distribution Program on Indian Reservations (FDPIR) do not need to list a Social Security number. Some children qualify for free meals without an application. Please contact your school to get free meals for a foster child, and children who are homeless, migrant, or runaway.
  • The contact information below is solely to file a complaint of discrimination In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410 (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov
  • Return completed form to your child's school.
  • * Do not ma il applications to this address, only complaints of discrimination.

  • USDA is an equal opportunity provider, employer, and lender.

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