ATCHISON COUNTY COMMUNITY SCHOOLS

Transcription

1 ATCHISON COUNTY COMMUNITY SCHOOLS Unified School istrict # Min Street PO Box 289 Effinghm, Knss 6623 er Prent/Gurdin: Children need helthy mels to lem. AtcMson County Community Schools US 377 offers helthy mels every school dy. Your children my qulify for free mels or for reduced price mels. Elementry (PS - 6) Jr. High (7-8) High School Mel Chrges Full Reduced Full Reduced Full Reduced Price Price Price Price Price Price S Lunch S Brekfst After School Snck An ppliction for free or reduced price mel benefits nd set of detiled instructions is included with this letter. Contct Theres Cttrell, , ctt-eut@usd377.org with. questions or to request n ppliction be sent. Below re some common, questions nd nswers to help you with the ppliction process. 1. WHO CAN GET FREE OR REUCE PRICE MEALS? AU children in households receiving benefits from. Food Assistnce (FA), the Food istribution Progrm on Indin Reservtions (FPIR) or Temporry Assistnce for Fmilies (TAP) re eligible for free mels. Foster children tht re under the legl responsibility of foster cre gency or court re eligible for free mels. Children, prticipting in their school's Hed Strt progrm re eligible for free mels. Children who meet the definition of homeless, runwy, or migrnt re eligible for free mels. Children my receive free or reduced price mels if your household's income is within. the limits on the Federl Income Eligibility Guidelines. Your children my qulify for free or reduced price mels if your household mcome flls t or below the limits on this chrt FEERAL ELIGIBILITY INCOME CHART For School Yer Yerly Monthly Household size Ech dditionl person: 22,459 3,451 38,443 46,435 54,427 62,419 7,411 78,43 7,992 1,872 2,538 3,24 3,87 4,536 5,22 5,868 6, Weekly ,47 1,21 1,355 1, HOW O I KNOW IF MY CHILREN QUALIFY AS HOMELESS, MIGRANT, OR RUNAWAY? o the members of your household lck permnent ddress? Are you stying together in shelter, hotel, or other temporry housing rrngement? oes your frcdly relocte on. sesonl bsis? Are ny children living with you who hve chosen to leve their prior fnuly or household? If you believe children m your household meet these descriptions nd hven't been. told your children will get free mels, plese cll or e-mil Atchison County Community Schools US 377, r. Andrew.Gddis O I NEE TO FILL OUT AN APPLICATION FOR EACH CHIL? No. Use one Free nd Reduced Price School Mels Appliction for ll students in your household. We cjmot pprove n ppliction, tht is not complete, so be sure to ffll out ll required mformtion. Return the completed ppliction to: Theres CttreH, 36 Mi St., PO Box 289, EfBnghm, KS. 6623, , cttreut@usd377.org. SHOUL I FILL OUT AN APPLICATION IF I RECEIVE A LETTER THIS SCHOOL YEAR SAYING MY CHILREN ARE ALREAY APPROVE FOR FREE MEALS? No, but plese red the letter you got crefully nd follow the mstmctions. If ny children in your household were missing from. your eligibility notifiction, contct Theres CttreU, 36 Min St., PO Box 289, Ef&nghm, KS. 6623, , cttreuf@usd377.org immeditely. Bord Office (913) Fx (913) Junior/Senior High School (913) Elementry School (913)

2 5. CAN I APPLY ONLINE? Not Avilble ^, Yes 6. MY CHIL'S APPLICATION WAS APPROVE LAST YEAR. O I NEE TO FILL OUT A NEW ONE? Yes. Your child's ppliction is only good for tht school yer nd for the first few dys of this school yer, through October 2, 218. You must send in new ppliction unless the school told you tht your child is eligible for the new school yer. If you do not send in new ppliction tht is pproved by the school or you hve not been notified tht your child is eligible for free mels, your child will be chrged the full price for mels. 7. I GET WIC. CAN MY CHILREN GET FREE MEALS? Children in households prticipting in WIC ms be eligible for free or reduced price mels. Plese send in n ppliction. 8. WILL THE INFORMATION I GIVE BE CHECKE? Yes. We my lso sk you to send written proof of the household income you report. 9. IF I ON'T QUALIFY NOW, MAY I APPLY LATER? Yes, you my pply t ny time during the school yer. For exmple, children with prent or gurdin who becomes unemployed my become eligible for free nd reduced price mels if the household income drops below the income Umit. 1. WHAT IF I ISAGREE WITH THE SCHOOL'S ECISION ABOUT MY APPLICATION? You should tlk to school officils. You lso my sk for hering by clling or writing to: r. Andrew Gddis, 36 Min St., PO Box 289, Effinghm, KS. 6623, , gddis.ndrew@usd377.org. 11. MAY I APPLY IF SOMEONE IN MY HOUSEHOL IS NOT A U.S. CITIZEN? Yes. You, your children, or other household members do not hve to be U.S. citizens to pply for free or reduced price mels. 12. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the mount tht you normlly receive. For exmple, if you normlly mke $1 ech month, but you missed some work lst month nd only mde $9, put down fht you mde $1 per month. If you normlly get overtime, include it,but do not include it if you only work overtime sometimes. If you hve lost job or hd your hours or wges reduced, use your current income. 13. WHAT IF SOME HOUSEHOL MEMBERS HAVE NO INCOME TO REPORT? Household members my not receive some types of income we sk you to report on the ppliction, or my not receive income t ll. Whenever this hppens, plese write in the field. However, if ny income fields re left empty or blnk, those will lso be counted s zeroes. Plese be creful when leving income fields blnk, s we will ssume you ment to do so. 14. WE ARE IN THE MILITARY. O WE REPORT OUR INCOME IFFERENTLY? Your bsic py nd csh bonuses must be reported s income. If you get ny csh vlue llownces for off-bse housing, food, or clothing, it must lso be included s income. However, if your housing is prt of the Militry Housing Privtiztion Inititive, do not include your housing llownce s income. Any dditionl combt py resulting from deployment is lso excluded from income. 15. WHAT IF THERE ISNT ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List ny dditionl household members on seprte piece of pper, nd ttch it to your ppliction. Contct Theres Cttrell, 36 Min St., PO Box 289, Effmghm, K , , cttrellt@usd377.org to receive second ppliction. 16. MY FAMILY NEES MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to pply for Food Assistnce (FA) or other ssistnce benefits, contct your locl ssistnce office or cll If you hve other questions or need help, cll Sincerely, Theres Cttrell US 377 Food Service irector This institution is n equl opportunity provider.

3 Household Appliction for Free nd Reduced Price School Mels Complete one ppliction per household. Plese use pen (not pencil).! efinition of Household Member: "Anyone who is living with you nd shres \ income nd expenses, even \ if not relted." \ Children in Foster cre nd children who meet the definition of Homeless, Migrnt or Runwy re eligible for free mels. Red ; How to Apply for Free nd / I Reduced Price School / Mels for more informtion y Child's First Nme Ml Child's Lst Nme School Grde Student? Yes No L^J ^ I s cu g (U X: Foster Child I I n Homeless Migrnt, Runwy u i l LJ lfi^^^^^^^^^%i^^^^^^^^1.i^^^ffi<m^^^ffi^^%i%^^^?l?^^^^^i^^ll If NO Go to STEP 3. If YES > Write cse number here then go to STEP 4 (o not complete STEP 3) Cse Number: Write only one cse number in this spce. Are you unsure wht income to Include here? Flip the pge nd review the chrts titled "Sources of Income" for more informtion. The "Sources of Income for Children" chrt will help you with the Child Income section. The "Sources of Income for Adults" chrt will help you with the All Adult Household Members section. Flip the pge to lern how to report Income from Self Employment. A. Child Income Sometimes children in the household ern or receive income. Plese include the TOTAL income received by ll Household Members listed in STEP 1 here. B. All Adult Household Members (including yourself) $ Child income Weekly BI-Weekly 2x Month Monthly List ll Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For ech Household Member listed, if they do receive income, report totl gross income (before txes) for ech source in whole dollrs (no cents) only. If they do not receive income from ny source, write ''. If you enter '' or leve ny fields blnk, you re certifying (promising) tht there is no income to report. Nme of Adult Household Members (First nd Lst) Totl Household Members (Children nd Adults) How often? Ernings from Wlk vifeekly Bi-We8kly 2x Month ] Monlhly /fwn\,^?\ ^"\ ^ l:.j' \^ r-\ ' ' ^J \J '"^J- \...,! Lst Four igits of Socil Security Number (SSN) of Primry Wge Erner or Other Adult Household Member How often? Public Assistnce/ Child Support/Alimony [Weekly i Bi-Weeklyl 2x Monlh I Monlhly! X! X X.^\ ^' n\,,y.f"'\ kj x i x /-^ ^-. ^ L/ ^ \^ u u "\ ^"\ $1 A!l Other Income $1 I $1 $1 Check if no SSN Weekly /,, /'""> k^ / "^ u How often? B-WeekM 2x Month / \ u r'\ \^',^"\ \J \,,/ r~\ v..--' \.^ ^"">. \^ /"'', ' -..^.^ -v Monlhly?"*\ '<,/' \^ r-... v^ "I certify (promise) tht ll informtion on this ppliction is true nd tht ll income is reported. I understnd tht this informtion is given in connection with the receipt of Federl funds, nd tht school officils my verify (check) the informtion. I m wre tht if I purposely give flse informtion, my children my lose mel benefits, nd I my be prosecuted under pplicble Stte nd Federl lws." Street Address (if vilble) Apt # City Stte Zip ytime Phone nd Emil (optionl) Printed nme of dult signing the form Signture of dult Tody's dte

4 Sources of Child Income Ernings from work Socil Security - isbility Pyments Survivor's Benefits Income from person outside the household Income from ny other source Sources of Income for Children Exmple(s) A child hs regulr full or prt-time job where they ern slry.or wges A child is blind or disbled nd receives Socil Security benefits A Prent is disbled, retired, or decesed, nd their child receives Socil Security benefits A friend or extended fmily member regulrly gives child sgending money A child receives regulr income from privte pension fund, nnuity, or trust Slry, wges, csh bonuses Net income from selfemployment (frm or business If you re in the U.S. Militry: Bsic py nd csh bonuses (do NOT include combt py, FSSA or privtized housing llownces) Allownces for off-bse housing, food nd clothing Sources of Income for Adults Unemployment benefits Worker's compenstion Supplementl Security Income (SSI) Csh ssistnce from Stte or locl government Alimony pyments Child support pyments Vetern's benefits Strike benefits Socil Security (including rilrod retirement nd blck lung benefits) Privte pensions or disbility benefits Regulr income from trusts or esttes Annuities Investment income Erned interest Rentl income Regulr csh pyments from outside household Income from Self Employment: Self-employed persons my use income tx records for the preceding clendr yer s bse to project the current yer's net income, unless the current monthly income provides more ccurte mesure. Report income derived from the business venture less operting costs incurred in the genertion of tht income. eductions for personl expenses such s interest on home pyments, medicl expenses, nd other similr non-business deductions re not llowed in reducing gross business income. Additionl income from other kinds of employment must be treted s seprte nd prt from the income generted or lost from your business venture. For exmple, if you operted business t net loss, but held dditionl employment for which slry ws received, the income for purposes of pplying for reduced price or free mels would be the income from the slry only. The loss from the business cnnot be deducted from positive income erned in other employment. For purposes of this ppliction, it is not possible to report negtive income from ny business venture. The lest income possible is zero (no income). The necessry informtion for rriving t llowble income from privte business opertion my be tken from your most recent U.S. Individul Income Tx Return - Form 14. Add together the mounts reported on the following lines: LINE 12 LINE 13 LINE 14 LINE 17 LINE 18 TOTAL Computed Monthly Income Business Income or (Loss) Cpitl Gin or (Loss) Other Gins or (Losses) Rentl rel estte, roylties, prtnerships, S corportions, trusts, etc. Frm Income or (Loss) Gross Annul Income Before Any eductions. Gross Annul Income - 12 = Computed Monthly Income. Report in Step 3. We re required to sk for informtion bout your children's rce nd ethnicity. This informtion is importnt nd helps to mke sure we re fully serving our community. Responding to this section is optionl nd does not ffect your children's eligibility for free or reduced price mels. Ethnicity (check one): Rce (check one or more): Hispnic or Ltino Not Hispnic or Ltino Americn Indin or Alskn Ntive Asin d Blck or Africn Americn Ntive Hwiin or Other Pcific Islnder White The Richrd B. Russell Ntionl School Lunch Act requires the informtion on this ppliction. You do not hve to give the informtion, but if you do not, we cnnot pprove your child for free or reduced price mels. You must include the lst four digits of the socil security number of the dult household member who signs the ppliction. The lst four digits of the socil security number is not required when you pply on behlf of foster child or you list Food Assistnce (FA) Temporry Assistnce for Fmilies CTAF) Progrm or Food istribution Progrm on Indin Reservtions (FPIR) cse number or other FPIR identifier for your child or when you indicte tht the dult household member signing the ppliction does not hve socil security number. We will use your informtion to determine if your child is eligible for free or reduced price mels, nd for dministrtion nd enforcement of the lunch nd brekfst progrms. We MAY shre your eligibility informtion with eduction, helth, nd nutrition progrms to help them evlute, fund, or determine benefits for their progrms, uditors for progrm reviews, nd lw enforcement officils to help them look into violtions of progrm rules. In ccordnce with Federl civil rights lw nd U.S. eprtment of Agriculture (USA) civil rights regultions nd policies, the USA, its Agencies, offices, nd employees, nd institutions prticipting in or dministering USA progrms re prohibited from discriminting bsed on rce, color, ntionl origin, sex, disbility, ge, or reprisl or retlition for prior civil rights ctivity in ny progrm or ctivity conducted or funded by USA. Persons with disbilities who require lterntive mens of communiction for progrm informtion (e.g. Brille, lrge print, udiotpe, Americn Sign Lnguge, etc.), should contct the Agency (Stte or locl) where they pplied for benefits. Individuls who re def, hrd of hering or hve speech disbilities my contct USA through the Federl Rely Service t (8) Additionlly, progrm informtion my be mde vilble in lnguges other thn English. To file progrm complint of discrimintion, complete the USA Progrm iscrimintion Complint Form, (A-327) found online t: nd t ny USA office, or write letter ddressed to USA nd provide in the letter ll of the informtion requested in the form. To request copy of the complint form, cll (866) Submit your completed form or letter to USA by: (1) Mil: U.S. eprtment of Agriculture Office of the Assistnt Secretry for Civil Rights 14 Independence Avenue, SW Wshington,.C (2) Fx: (22) ; or (3) Emil: progrm.intke@usd.gov. This institution is n equl opportunity provider. Totl Income: $ How Often (Circle One): W BW 2M M Multiple=Yeriy Household Size: Ctegoricl Eligibility (FA, TAF, FPIR, Foster) Eligibility: Notes: Free OR Reduced Price OR enied etermining Officil's Signture: Approvl/enil te: Notifiction te: Processor's Initils: Confirming Officil's Signture (ONLY for pplictions to be verified): Review te:

5 APPLICATION PACKET FOR FREE AN REUCE PRICE SCHOOL MEALS How to Apply for Free nd Reduced Price School Mels. For trnslted mterils, go to School Nutrition Progrms, Administrtion, Foreign Lnguge Trnsltion. Plese use these instructions to help you fill out the ppliction for free or reduced price school mels. You only need to submit one ppliction per household, even if your children ttend more thn one school in Atchison County Community School US 377, The ppliction must be filled out completely to certify your children for free or reduced price school mels. Plese follow these instructions in order! Ech step of the instructions is the sme s the steps on your ppliction. If t ny time you re not sure wht to do next, plese contct Theres Cttrell, , cttrellt@usd377.org. PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AN O YOUR BEST TO PRINT CLEARLY. iisitl iffiiisisbbill@bibii?^ Tell us how mny infnts, children, nd school students live in your household. They do NOT hve to be relted to you to be prt of your household. Who should I list here? When filling out this section, plese include ALL members in your household who re: Children ge 18 or under AN re supported with the household's income; In your cre under foster rrngement, or qulify s homeless, migrnt, or runwy youth; Students ttending Atchison County Community Schools US 377, regrdless of ge. A) List ech cmld's nme. Print ech child's nme. Use one line of the ppliction for ech child. If there re more children present thn lines on the ppliction, ttch second piece of pper with ti required informtion for the dditionl children. SlEPNOANfH^ B) Is the child student t Atchison County Community School US 377? Mrk'Yes'or'No'under the <:olurnntitled "Student" to tell us which children ttend Atchison County Community Schools US 377. If you mrked 'Yes/write the nme of the school rid the grde level of the student in the 'SchooF nd 'Grde' columns to the. right. C) o you hve ny foster children? if ny children listed re foster children, mrk the "Foster Child" box next to the child's nme. If you re ONLY pplying for foster children/ fter finishing STEP 1, go to STEP 4. Foster<:hildren who live with you mv count s members of your household nd should be listed on vourplictioh.lfyou re pplying for both foster nd nbn-foster children, go to step 3. ) Are ny children homeless, migrnt, or runwy? If you believe ny child listed in this section meets this description, mrk the "Homeless, Migrnt, Runwy" box next to the child's nme nd coj-nelete ll steps of the pliction.. If nyone in your household (including you) currently prticiptes in one or more of the ssistnce progrms listed below, your children re eligible for free school mels: Food Assistnce (FA). Temporry Assistnce for Fmilies (TAF). The Food istribution Progrm on Indin Reservtions (FPIR). A) If no one in your household prticiptes in ny of the bove listed progrms: ^ Leve STEP 2 blnk nd go to STEP 3. STEPS: REPORT INCOIVIE FOR Al^ HOUSEHOL M How do I report my income? B) If nyone in your household prticiptes in ny of the bove listed progrms: Write cse ntimber for FA, TAF, or FPIR. You only need to provide one cse number. If you prticipte in one of these ^progrms nd do not khowyour cse number, contct Knss eprtment for Children nd Fmilies...;'GotoSTEP4.".-,:\--l/;;;^.IV.:'l'il;,.:-;;'1.:/-1:,.::-..^:,---';1.,,,'':., Use the chrts titled "Sources of Income for Adults" nd "Sources of Income for Children", printed on the bck side of the ppliction form to determine if your household hs income to report. Report ll mounts in GROSS INCOME ONLY. Report ll income in whole dollrs. o not include cents. o Gross income is the totl income received before txes. o Mny people think of income s the mount they "tke home" nd not the totl, "gross" mount. Mke sure tht the income you report on this ppliction hs NOT been reduced to py for txes, insurnce premiums, or ny other mounts tken from your py. Write "" in ny fields where there is no income to report. Any income fields left empty or blnk will lso be counted s zero. If you write '' or leve ny fields blnk, you re certifying (promising) tht there is no income to report. If locl officils suspect tht your household income ws reported incorrectly, your ppliction will be investigted. Mrk how often ech type of income is received using the check boxes to the right of ech field. Appliction Pcket for Free nd Reduced Price School Mels Pge 1

6 3.A. REPORT INCOME EARNE BY CHILREN A) Report ll income erned or receive by children. Report the combined gross income for ALL children listed in STEP 1 in your household in the box mrked "Child Income." Only count foster children's incomeffyou re ^ ; Wht is Chf/rf/ricomePChild income is rfiohey received from.outstde your hou^ pid IRECTLY to your children. Mny households do not hve ny child income. 3.B REPORT INCOME EARNE BY AULTS Who should I list here? When filling out this section, plese include ALL dult members in your household who re living with you nd shre income nd expenses, even if they re not relted nd even if they do not receive income of their own. o NOT include: o People who live with you but re not supported by your household's income AN do not contribute income to your household. o Infnts, Children nd students lredy listed in STEP 1. B) List dult household members' nmes. Print the nme of ech j household member in the boxfe mrked "Nmes of Adult Household Members (First nd Lst)." o not list ny household members you listed in STEP 1, If - child listed in STEP 1 hs income, follow the instructions in STEP 3,;prtA.';,:-.;.,;-,.^.^1'; - E) Report income from pensibns/retirement/ll other income. Report ll income tht pplies in the "Pensions/Refirement/ All Other Income" field on fhe ppliction. is1'ei^;ccir^?lntqrli^t C) Report ernings from work. Report I I inco me from work i n the ''Ernings from Work" field on the ppliction. This is usully the money receivedfrpm working t jobs. If you re self-employed business or frm Owner, you will report your net income. See detiled instructidris on the bck of the pptiction. Wht if I m self-employed'? Report income from tht work s net mount. This is clculted by subtrcting the totl operting expenses of your business from its gross receipts or revenue. F) Report totl household size. Enter the totl number of household members in the field "Totl Household Members (Children nd Adults). This number MUST be equl to the number of household members listed in STEP 1 nd STEP 3. tf there re ny members of your household tht you hve riot listed on the pplictidri, go bck nd dd them. It is very importnt to list ll household members, s the size of your household ffects your eligibility for free nd reduced price mets. ) Report income from public ssistnce/chitd supporf/limony. Report ll income tht pplies in the "Public Assistrtce/Child Support/Alimony" field on the ppliction. o. not report the csh vlue of ny public ssistnce benefits NOT listed on the chrt. If income is received from child support or limony,only report court-drdered pyments; Informl but regulr pyments should be reported s "other" income in the next prt. G) Provide the lst four digits of your Socil Security Number. An dult household member must enter the lst four digits of their Socil Security Number in the spce provided. You re eligible to pply for benefits even if you do not hve Socil Security Number; If no dult household members hve Socil Security Number, leve this spce blnk nd mrk the box to the right lbeled "Check if no SSN." All pplictions must be signed by n dult member of the household. By signing the ppliction, tht household member is promising tht ll informtion hs been truthfully nd completely reported. Before completing this section, plese lso mke sure you hve red the privcy nd civil rights sttements on the bck of the ppliction. A) Provide your contct informtibri. Write your current ddress in the fields provided if this informtion'^ vilble.tf you hve no permnent ddress, this does not mke your children ineligibte for free or reduced price school mels.shring phone number, emil ddress, pr both is dptibnl; but helps us rech you quickly if We need to contct you. ; 8) Print rid sign your nme nd Write tody's dte; Print the nme of the dult signing the ppliction nd tht person signs in the box "Signture of dult." C) Mil Completed Form to: 36 Min St., FO Box 289, Effinghm.KS ) Shre children's rcil nd ethnic identities (optionl). On the bck of the ppliction, we sk you to shre informtion bout your children's rce nd ethnicity.this field is optionl-nd does not ffect your children's eligibility for free or reduced price school mels. Appliction Pcket for Free nd Reduced Price School Mels Pge 2