FREQUENTLYASKEDQUESTIONSABOUT

FREEANDREDUCED-PRICESCHOOLMEALS

DearParent/Guardian:

Childrenneedhealthymealstolearn.Asher Public Schoolsoffershealthymealseveryschoolday.Breakfastcosts($.75);lunchcosts(PK-4th $1.25/5th -12th $1.50). Yourchildrenmayqualifyforfreemealsorforreduced-pricemeals.

Reduced-priceis($.25)forbreakfastand($.40)forlunch.Thispacketincludesanapplicationforfreeorreduced-price mealbenefitsandasetofdetailedinstructions.Belowaresomecommonquestionsandanswerstohelpyouwiththe applicationprocess.

1.WHOCANGETFREEORREDUCED-PRICEMEALS?

•AllchildreninhouseholdsreceivingbenefitsfromSupplementalNutritionAssistanceProgram (SNAP),FoodDistributionProgramonIndianReservationsFDPIR),orTemporaryAssistanceforNeedyFamilies (TANF)areeligibleforfreemeals.

•Fosterchildrenwhoareunderthelegalresponsibilityofafostercareagencyorcourtareeligiblefor freemeals.

•Childrenparticipatingintheirschool’sHeadStartprogramareeligibleforfreemeals.

•Childrenwhomeetthedefinitionofhomeless,runaway,ormigrantareeligibleforfreemeals.

•Childrenmayreceivefreeorreduced-pricemealsifyour household’s incomeiswithinthelimitsontheFederalIncomeEligibilityGuidelines.Yourchildrenmayqualifyforfreeorreduced-pricemealsif yourhouseholdincomefallsatorbelowthelimitsonthischart.

FEDERALELIGIBILITYINCOMECHARTforSchoolYear:2016
HouseholdSize / Yearly / Monthly / Weekly
1 / 21,775 / 1,815 / 419
2 / 29,471 / 2,456 / 567
3 / 37,167 / 3,098 / 715
4 / 44,863 / 3,739 / 863
5 / 52,559 / 4,380 / 1,011
6 / 60,255 / 5,022 / 1,159
7 / 67,951 / 5,663 / 1,307
8 / 75,647 / 6,304 / 1,455
Eachadditionalperson: / 7,696 / 642 / 148

2.HOWDOIKNOWIFMYCHILDRENQUALIFYASHOMELESS,MIGRANT,ORRUNAWAY?Dothemembersofyourhouseholdlackapermanentaddress?Areyoustayingtogetherinashelter,hotel,orothertemporaryhousingarrangement?Doesyourfamilyrelocateonaseasonalbasis?Areanychildrenliving withyouwhohavechosentoleavetheirpriorfamilyorhousehold?Ifyoubelievechildreninyourhousehold meetthesedescriptionsandhavenotbeentoldyourchildrenwillgetfreemeals,pleasecallore-mail(Asher Public School,orShawna Magby, ).

3.DOINEEDTOFILLOUTANAPPLICATIONFOREACHCHILD?No.UseoneFreeandReduced-PriceSchoolMealsApplicationforallstudentsinyourhousehold.Wecannotapproveanapplicationthatisnotcomplete,sobesuretofilloutallrequiredinformation.Returnthecompletedapplicationto:Rebecca Yott, 201 S. Division, Asher,Ok 405-784-2331.

4.SHOULDIFILLOUTANAPPLICATIONIFIRECEIVEDALETTERTHISSCHOOLYEARSAYINGMYCHILDRENAREALREADY APPROVEDFORFREEMEALS?No,butpleasereadtheletteryougotcarefullyandfollowtheinstructions. Ifanychildreninyourhouseholdweremissingfromyoureligibilitynotification,contact(Rebecca Yott,201 S. Division, Asher, Ok, 405-784-2331, )immediately.

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5.CANIAPPLYONLINE?Yes!Youareencouragedtocompleteanonlineapplicationinsteadofapaperapplicationifyouareable.Theonlineapplicationhasthesamerequirementsandwillaskyouforthesame informationasthepaperapplication.Visitasher.k12.ok.ustobeginortolearnmoreabouttheonlineapplicationprocess.ContactRebecca Yott,405*784*2331, ifyouhaveanyquestionsabouttheonlineapplication.

6.MYCHILD’SAPPLICATIONWASAPPROVEDLASTYEAR.DOINEEDTOFILLOUTANEWONE?Yes.Yourchild’sapplicationisonlygoodforthatschoolyearandforthefirstfewdaysofthisschoolyear.Youmustsendinanewapplicationunlesstheschooltoldyouthatyourchildiseligibleforthenewschoolyear.

7.IGETWIC.CANMYCHILDRENGETFREEMEALS?ChildreninhouseholdsparticipatinginWICMAY

beeligibleforfreeorreduced-pricemeals. Pleasesendinanapplication.

8.WILLTHEINFORMATIONIGIVEBECHECKED?Yes.We mayalsoaskyoutosendwrittenproofofthehouseholdincomeyoureport.

9.IFIDONOTQUALIFYNOW,MAYIAPPLYLATER?Yes,youmayapplyatanytimeduringtheschoolyear.Forexample,childrenwithaparentorguardianwhobecomesunemployedmaybecomeeligibleforfreeand reduced-pricemealsifthehouseholdincomedropsbelowtheincomelimit.

10.WHATIFIDISAGREEWITHTHESCHOOL’SDECISIONABOUTMYAPPLICATION?Youshouldtalktoschoolofficials.Youalsomayaskforahearingbycallingorwritingto:(Terry Grissom,201 S. Division, Asher, Ok, 405-784-2331, ).

11.MAYIAPPLYIFSOMEONEINMYHOUSEHOLDISNOTAUNITEDSTATES(U.S.)CITIZEN?Yes.You,yourchildren,orotherhouseholdmembersdonothavetobeU.S.citizenstoapplyforfreeorreduced-price meals.

12.WHATIFMYINCOMEISNOTALWAYSTHESAME?ListtheamountthatyouNORMALLYreceive.Forexample,ifyounormallymake$1000eachmonth,butyoumissedsomeworklastmonthandonlymade

$900,putdownthatyoumade$1000permonth.Ifyounormallygetovertime,includeit,butdonotinclude itifyouonlyworkovertimesometimes.Ifyouhavelostajoborhadyourhoursorwagesreduced,useyour currentincome.

13.WHATIFSOMEHOUSEHOLDMEMBERSHAVENOINCOMETOREPORT?Householdmembersmaynotreceivesometypesofincomeweaskyoutoreportontheapplicationormaynotreceiveincomeatall. Whenever this happens, please write a 0 in the field.However, if any income fields are left empty or blank,thosewillALSObecountedaszeroes.Pleasebecarefulwhenleavingincomefieldsblank,aswewillassumeyouMEANTtodoso.

14.WEAREINTHEMILITARY.DOWEREPORTOURINCOMEDIFFERENTLY?Yourbasicpayandcashbonusesmustbereportedasincome.Ifyougetanycashvalueallowancesforoff-basehousing,food,or clothingorreceiveFamilySubsistenceSupplemental Allowance payments or the Military Housing Privatization Initiative,donotincludeyourhousing allowanceasincome.Anyadditionalcombatpayresultingfromdeploymentisalsoexcludedfromincome.

15.WHATIFTHEREISNOTENOUGHSPACEONTHEAPPLICATIONFORMYFAMILY?Listanyadditional householdmembersonaseparatepieceofpaper,andattachittoyourapplication.ContactRebecca Yott,201 S. Division Asher,405*784*2331, )toreceiveasecondapplication.

16.MYFAMILYNEEDSMOREHELP.ARETHEREOTHERPROGRAMSWEMIGHTAPPLYFOR?Tofindouthowtoapplyfor(SNAP)orotherassistancebenefits,contactyourlocalassistanceofficeorcall1*866*411*1877.

Ifyouhaveotherquestionsorneedhelp,call405*784*2331).Sincerely,

Rebecca Yott

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HOWTOAPPLYFORFREEANDREDUCED-PRICESCHOOLMEALS

Pleaseusetheseinstructionstohelpyoufillouttheapplicationforfreeorreduced-priceschoolmeals.YouonlyneedtosubmitONEapplicationperhousehold,evenifyourchildrenattendmorethanoneschoolinAsher Public Schools).Theapplicationmustbefilledoutcompletelytocertifyyourchildrenforfreeorreduced-priceschoolmeals.

Pleasefollowtheseinstructionsinorder!Eachstepoftheinstructionsisthesameasthestepsonyourapplication. Ifatanytimeyouarenotsurewhattodonext,pleasecontactAsher Public School / Rebecca Yott/405*784*2331/ .

PLEASEUSEAPEN(NOTAPENCIL)WHENFILLINGOUTTHEAPPLICATION,ANDDOYOURBESTTOPRINTCLEARLY.

Tellushowmanyinfants,children,andschoolstudentsliveinyourhousehold.TheydoNOThavetoberelatedtoyoutobeapartofyourhousehold.

A.Listeachchild’sname.Foreachchild,printhis/herfirstname,middleinitial,andlastname.Useonelineoftheapplicationforeachchild.Iftherearemorechildrenpresentthanlinesontheapplication,attachasecond pieceofpaperwithallrequiredinformationfortheadditionalchildren.

B.IsthechildastudentatAsher Public Schools? MarkYesorNounderthecolumntitled

StudenttotelluswhichchildrenattendAsher Public Schools.

C.Doyouhaveanyfosterchildren?Ifanychildrenlistedarefosterchildren,marktheFosterChildboxnextto thechild’sname.Fosterchildrenwholivewithyoumaycountasmembersofyourhouseholdandshouldbelistedonyourapplication.IfyouareONLYapplyingforfosterchildren,aftercompletingSTEP 1,skiptoSTEP4oftheapplicationandtheseinstructions.

D.Areanychildrenhomeless,migrant,orrunaway?Ifyoubelieveanychildlistedinthissectionmaymeetthis description,pleasemarktheHomeless,Migrant,Runawayboxnexttothechild’snameandcompleteallstepsoftheapplication.

Ifanyoneinyourhouseholdparticipatesintheassistanceprograms,yourchildrenareELIGIBLEforfreeschoolmeals.

IfNOONEinyourhouseholdparticipatesinanyoftheaboveprograms:

•SkiptoSTEP3ontheseinstructionsandSTEP3onyourapplication.

•LeaveSTEP2blank.

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A.Reportallincomeearnedbychildren.RefertothecharttitledSourcesofIncomeforChildrenintheseinstructions,andreportthecombinedgrossincomeforALLchildrenlistedinSTEP1inyourhouseholdintheboxmarkedTotalChildIncome.Onlycountfosterchildren’sincomeifyouareapplyingforthemtogetherwiththerestofyourhousehold.Itisoptionalforthehouseholdtolistfosterchildrenlivingwiththemaspartofthe household.

SourcesofIncomeforChildren
SourcesofChildIncome / Example(s)
•Earningsfromwork / •A child has a job where he/she earns a salary or wages
•SocialSecurity
—Disabilitypayments
—Survivor’sbenefits / •Achildisblindordisabledandreceivessocial
securitybenefits
•Aparentisdisabled,retired,ordeceased,andhis/ herchildreceivessocialsecuritybenefits
•IncomefrompersonsOUTSIDEthehousehold / •Afriendorextendedfamilymember
REGULARLYgivesachildspendingmoney
•Incomefromanyothersource / •Achildreceivesincomefromaprivatepension
fund, annuity, or trust

FOREACHADULTHOUSEHOLDMEMBER:

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FOREACHADULTHOUSEHOLDMEMBER:cont.

B.Listadulthouseholdmembers’names.PrintthenameofeachhouseholdmemberintheboxesmarkedNamesofAdultHouseholdMembers(FirstandLast).DonotlistanyhouseholdmembersyoulistedinSTEP1. IfachildlistedinSTEP1hasincome,followtheinstructionsinSTEP3,PartA.

C.Reportearningsfromwork.RefertothecharttitledSourcesofIncomeforAdultsintheseinstructions,andreportallincomefromworkintheEarningsFromWorkfieldontheapplication.Thisisusuallythemoneyreceivedfromworkingatjobs.Ifyouareaself-employedbusinessorfarmowner,youwillreportyournetincome.Thisiscalculatedbysubtractingthetotaloperatingexpensesofyourbusinessfromitsgrossreceiptsor revenues.

D.Reportincomefrompublicassistance/childsupport/alimony.RefertothecharttitledSourcesofIncomeforAdultsintheseinstructions,andreportallincomethatappliesinthePublicAssistance/ChildSupport/Alimony fieldontheapplication.DonotreportthevalueofanycashvaluepublicassistancebenefitsNOTlistedonthechart.Ifincomeisreceivedfromchildsupportoralimony,onlycourt-orderedpaymentsshouldbereportedhere. InformalregularpaymentsshouldbereportedasOtherincomeinthenextpart.

E.Reportincomefrompensions/retirement/allotherincome.RefertothecharttitledSourcesofIncomeforAdultsintheseinstructions,andreportallincomethatappliesinthePensions/Retirement/AllOtherIncomefieldontheapplication.

F.Reporttotalhouseholdsize.EnterthetotalnumberofhouseholdmembersinthefieldTotalHouseholdMembers(ChildrenandAdults).ThisnumberMUSTbeequaltothenumberofhouseholdmemberslistedinSTEP1andSTEP3.Ifthereareanymembersofyourhouseholdthatyouhavenotlistedontheapplication,gobackandadd them.Itisveryimportanttolistallhouseholdmembers,asthesizeofyourhouseholddeterminesyourincome cutoffforfreeandreduced-pricemeals.

G.Providethelastfourdigitsofyoursocialsecuritynumber.Thehousehold’sprimarywageearneroranotheradulthouseholdmembermustenterthelastfourdigitsofhis/hersocialsecuritynumberinthespaceprovided. Youareeligibletoapplyforbenefitsevenifyoudonothaveasocialsecuritynumber.Ifnoadulthouseholdmemberhasasocialsecuritynumber,leavethisspaceblankandmarktheboxtotherightlabeledCheckifnoSSN.

SourcesofIncomeforAdults
EarningsFromWork / PublicAssistance/Alimony/ChildSupport / Pensions/Retirement/AllOtherIncome

•Salary,wages,cashbonuses

•NETincomefromself-employment(farmorbusiness)
•Strikebenefits
IfyouareintheU.S.Military:
•Basicpayandcashbonuses(doNOTincludecombatpay,FSSA,orprivatizedhousingallowances)

•Allowancesforoff-base housing,food,andclothing

/ •Unemploymentbenefits
•Worker’scompensation
•SupplementalSecurityIncome(SSI)
•Cashassistancefromstateor localgovernment
•Alimonypayments
•Childsupportpayments
•Veteran’sbenefits / •SocialSecurity(including
railroadretirementandblack lungbenefits)
•Private pensions or disability
•Incomefromtrustsorestates
•Annuities
•Investmentincome
•Earnedinterest
•Rentalincome
•REGULARcashpaymentsfromoutsidehousehold

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Allapplicationsmustbesignedbyanadultmemberofthehousehold.Bysigningtheapplication,thathousehold memberispromisingthatallinformationhasbeentruthfullyandcompletelyreported.Beforecompletingthis section,pleasealsomakesureyouhavereadtheprivacyandcivilrightsstatementsontheapplication.

A.Provideyourcontactinformation.Writeyourcurrentaddressinthefieldsprovidedifthisinformationisavailable.Ifyouhavenopermanentaddress,thisdoesnotmakeyourchildrenineligibleforfreeorreduced-priceschoolmeals.Sharingaphonenumber,e-mailaddress,orbothisoptional,buthelpsusreachyouquicklyifweneedtocontactyou.

B.Printandsignyourname.PrintyournameintheboxPrintedNameofAdultCompletingtheForm.Signyour nameintheboxSignatureofAdultCompletingtheForm.

C.Today’sdate. Inthespaceprovided,writetoday’sdate.

D.Sharechildren’sracialandethnicidentities(optional).Onthebackoftheapplication,weaskyoutoshareinformationaboutyourchildren’sraceandethnicity.Thisfieldisoptionalanddoesnotaffectyourchildren’seligibilityforfreeorreduced-priceschoolmeals.

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2015-2016ApplicationforFreeandReduced-PriceSchoolMealsCompleteoneapplicationperhousehold. Pleaseuseapen(notapencil).

asher.k12.ok.us

DefinitionofHouseholdMember—Anyonewhois livingwithyouandshares incomeandexpenses,evenifnotrelated.

Childreninfostercareandchildrenwhomeetthedefi-nitionofhomeless,mi-grant,orrunawayareeli- gibleforfreemeals.ReadHowtoApplyforFreeandReduced-PriceSchoolMealsformoreinforma-tion.

Child’sFirstNameMIChild’sLastNameSchoolNameBirthDate Student?

Yes No

FosterChild Homeless,

Migrant, Runaway

IfyoudonotreceiveSNAP,TANF,orFDPIRbenefits,completeSTEP3. IfyoureceiveSNAP,TANF,orFDPIRbenefits,writeacasenumberhere,thengotoSTEP4. (DonotcompleteSTEP3.)

CaseNumber:

Write only one case number in this space.

PleasereadHowtoApplyforFreeandReduced-PriceSchoolMealsformoreinformation.TheSourcesofIncomeforChildrensectionwillhelpyouwiththeChildIncomequestion.TheSourcesofIncomeforAdultssec-tionwillhelpyouwiththeAllAdultHouseholdMemberssec-tion.

NamesofAdultHouseholdMembers(FirstandLast)

A.ChildIncome

Sometimeschildreninthehouseholdearnincome.PleaseincludethetotalincomeearnedbyallchildreninthehouseholdlistedinSTEP1here.$

B.AllAdultHouseholdMembers(IncludingYourself)

ListallhouseholdmembersnotlistedinSTEP1(includingyourself),eveniftheydonotreceiveincome.Foreachhouseholdmemberlisted,ifhe/shereceivesincome,reporttotalincomeforeachsourceinwholedollarsonly.Iftheydonotreceiveincomefromanysource,write0.Ifyouenter0orleaveanyfieldsblank,youarecertifying(promising)thatthereisnoincometoreport.

$$$

$$$

$$$

$$$

$$$

TotalHouseholdMembers(ChildrenandAdults)LastFourDigitsofSocialSecurityNumber(SSN)CheckifNoSSN

ofPrimaryWageEarnerorOtherAdultHouseholdMember

STEP4Contactinformationandadultsignature

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 (check) the information.I am aware that if I purposely give false information, mychildrenmaylosemealbenefitsandImaybeprosecutedunderapplicablestateandfederallaws.

StreetAddress(ifapplicable)

CityStateZipCodeDaytimePhoneandE-Mail(Optional)

PrintedNameofAdultCompletingtheFormSignatureofAdultCompletingtheFormToday’sDate

OPTIONALChildren’sRacialandEthnicIdentities
Wearerequiredtoaskforinformationaboutyourchildren’sraceandethnicity. Thisinformationisimportantandhelpstomakesurewearefullyservingourcommunity.Respondingtothissectionisoptionalanddoesnotaffectyourchildren’seligibilityforfreeorreduced-pricemeals.
Ethnicity(CheckOne):Race(CheckOneorMore):
HispanicorLatinoAmericanIndianorAlaskanNative
NotHispanicorLatinoAsian
BlackorAfricanAmerican
NativeHawaiianorOtherPacificIslander White
DONOTFILLOUTTHISPART.THISISFORSCHOOLUSEONLY
AnnualIncomeConversion: Weeklyx52,Every2Weeksx26,TwiceaMonthx24,Monthlyx12

Total Income:Per:Week,Every 2Weeks,Twice a Month,Month,YearHouseholdSize:
______
CategoricalEligibility:Eligibility: FreeReducedDeniedDateWithdrawn ReasonforDenialorWithdrawal: ______DeterminingOfficial’sSignature: ______Date: ______ConfirmingOfficial’sSignature: ______Date: ______VerifyingOfficial’sSignature: ______Date: ______
TheRichardB.RussellNationalSchoolLunchActrequirestheinformationonthisapplication.Youdonothavetogivetheinformation,butifyoudonot,wecannotapproveyourchildforfreeorreduced-pricemeals.Youmustincludethelastfourdigitsofthesocialsecuritynumberoftheadulthouseholdmemberwhosignstheapplication.Thelastfourdigitsofthesocialsecuritynumberarenotrequiredwhenyouapply on behalf of a foster child or you list a Supplemental NutritionAssistance Program (SNAP),TemporaryAssistance for NeedyFamilies(TANF)Program,orFoodDistributionProgramonIndianReservations(FDPIR)casenumberorotherFDPIRidentifierforyourchildorwhenyouindicatethattheadulthouseholdmembersigningtheapplicationdoesnothaveasocialsecuritynumber.Wewilluseyourinformationtodetermineifyourchildiseligibleforfreeorreduced-pricemealsandforadministrationandenforcementofthelunchandbreakfastprograms.WeMAYshareyoureligibilityinformationwitheducation,health,andnutritionprogramstohelpthemevaluate,fund,ordeterminebenefitsfortheirprograms,auditorsforprogramreviews,andlawenforcementofficialstohelpthemlookintoviolationsofprogramrules.
TheUnitedStatesDepartmentofAgriculture(USDA)prohibitsdiscriminationagainstitscustomers,employees,andapplicantsforemploymentonthebasesofrace,color,nationalorigin,age,disability,sex,genderidentity,religion,reprisal,andwhereapplicable,politicalbeliefs,maritalstatus,familialorparentalstatus,sexualorientation,orallorpartofanindividual’sincomeisderivedfromanypublicassistanceprogram,orprotectedgeneticinformationinemploymentorinanyprogramoractivityconductedorfundedbytheDepartment.(Notallprohibitedbaseswillapplytoallprogramsand/oremploymentactivities.)
IfyouwishtofileaCivilRightsprogramcomplaintofdiscrimination,completetheUSDAProgramDiscriminationComplaintForm,foundonlineat<
Individualswhoaredeaf,hardofhearing,orhavespeechdisabilitiesmaycontactUSDAthroughtheFederalRelayServiceat800-877-8339or800-845-6136(Spanish).

USDAisanequalopportunityproviderandemployer.

SHARINGINFORMATIONWITHMEDICAID/SOONERCARE

DearParent/Guardian:

Ifyourchildrengetfreeorreduced-priceschoolmeals,theyMAYalsobeabletogetfreeorlow-costhealthinsurancethroughMedicaidorSoonerCare.Childrenwithhealthinsurancearemorelikelytogetregular health care and are less likely to miss school because of sickness.

Becausehealthinsuranceissoimportanttochildren’swell-being,thelawallowsustotellMedicaidandSoonerCarethatyourchildrenareeligibleforfreeandreduced-priceschoolmealsunlessyoutellusnot to.MedicaidandSoonerCareonlyusetheinformationtoidentifychildrenwhomaybeeligiblefortheir programs.Programofficialsmaycontactyoutooffertoenrollyourchildren.FillingouttheApplicationforFreeandReduced-PriceMealsdoesnotautomaticallyenrollyourchildreninhealthinsurance.

IfyoudonotwantustoshareyourinformationwithMedicaidorSoonerCare,fillouttheformbelowand sendin. (Sendinginthisformwillnotchangewhetheryourchildrengetfreeorreduced-priceschool meals.)

No!IDONOTwantinformationfrommyApplicationforFreeandReduced-PriceSchoolMealssharedwithMedicaidorSoonerCare.

IfyoucheckedNo,fillouttheformbelowtoensurethatyourinformationisNOTsharedforthechild(ren)listedbelow:

Child’sName:School: Child’sName: School: Child’sName: School: Child’sName: School:

SignatureofParent/Guardian:Date: Printed Name:

Address:

For more information, you may call your child’s school.

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