Free and Reduced Price School Meals Application and Verification Forms

School Year _____-_____
Instructions For School Districts

This packet contains prototype forms:

Required information that must be provided to households:

  • Letter to Households
  • Free and Reduced Price School Meals Application
  • Notice to Households of Approval/Denial of Benefits1 (notification is required if household is denied)

Required information for households selected for verification of eligibility information materials:

  • Notification of Selection for Verification of Eligibility
  • Letter of Verification Results

Optional application-related materials that may be provided to households:

  • Sharing Information with Medicaid/SCHIP
  • Sharing Information with Other Programs
  • Notice to Households of Approval/Denial of Benefits1 (notification is optional if household is approved)
  • Notice of Direct Certification

The pages are designed to be printed on 8½” by 11” paper. Some pages may be printed front and back. You will need to identify the benefits that are offered in your school, such as afterschool snacks. The [bold, bracketed fields]indicate where you need to insert school district specific information. For example, you must include your district’s no-charge telephone number for verification assistance on the verification materials. If these materials have not been modified to include your State’s name for the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, Temporary Assistance to Needy Families (TANF), State Children’s Health Insurance Program (SCHIP), or, if applicable, to add Food Distribution Program on Indian Reservations (FDPIR), you should insert this information as appropriate. This prototype application package includes information regarding the exclusion of housing allowance for those in the Military Housing Privatization Initiative. If this is not pertinent to your school district, please modify as appropriate.

Your State agency may require you to submit your application package for approval. If you have questions, contact:

[State agency address]

1All households must be notified of their eligibility status. Households with children who are denied benefits must be given written notification of the denial. The notification must advise the household of the reason for the denial of benefits, the right to appeal, instruction on how to appeal, and a statement that the family may re-apply for free and reduced price meal benefits at any time during the school year. Households with children who are approved for free or reduced price benefits may be notified in writing or orally.

Free and Reduced Price School Meals Application

Instructions for School Districts

Page 1 of 1

July 2011 - Language

[Insert School District Letterhead]

Achengicheng Saam me Inn/Chóón tumwun:

Semiriit repwe mongo mongon epwe apechokuner ar repwe kaéé.[Name of School]a awora mongo mi apechokuna iteitan ranin sukuun. Niwinin mongon nesossor[$];niwinin mongon neanowas[$]. Noum kewe semiriit ra tongeni aninis ren an esapw kamé aner mongo ika fen kekisinó niwinin aner mongo.Niwinin mongo mi kekisino ukukun[$] ren mongon nesossor iwe[$]ren mongon neanowas.

  1. UPWE AMASOWA EW APINIKEISON REN EMON ME EMON NEI KEWE SEMIRIIT?Aapw. Amasowa ewe apinikeison om kopwe tungor an esapw kamé ikakekisinón niwinin mongo.Sise tongeni etiwa ew apinikeison ika ese wes amasowan, ina pwata kopwe amasowanong meinisin ekkewe pworaus mi mak pwe kopwe amasowanong. Eniwini ewe apinikeison a amasow ngeni: [name, address, phone].
  2. io a tongeni angei ekkei mongo ese kamé? Meinisin semiriit non ekkewe iimw ra angei aninis seni [State SNAP], [the Food Distribution Program on Indian Reservations]ika[StateTANF],a tongeni wor aner mongo ese kamé esapw anongonong won ar moni tonong. Noumw kewe semiriit ra pwan tongeni angei aner mongo ese kamé ika pwe kapachenapen moni tongon non ewe iim mi nomw non ewe aukuk mi affat non an mwuun Merika we Annukun Tufichin Aninis Anongonon won Moni Tonong.
  3. MI TUFICH AN EKKEWE SEMIRIIT RA NOMW FAN NEMENIEN MWUUN REPWE MONGO NGE ESAPW KAMÉ?Ewer, ekkewe semiriit ra nomw fan nemenien mwuun mi chiwen nomw non annuk pwe wisen ewe ofes a kan tumunu ekkei semiriit ika kapwung, ra tufich ar repwe mongo esapw kamé.Io we semiriit a nomw fan tumwunuan mwuun non ewe iim a tongeni mongo ekkewe mongo ese kamé esapw pwan anongonong won moni tonong.
  1. Mi TUFICH AN EKKEWE SEMIRIIT ESE WOR IMWER, EKKEWE RA SU SENI IMWER, ME EKKEWE IR CHON EW FÉNU REPWE TONGENI MONGO ESAPW KAMÉ?Ewer, semiriit ekkewe iir mi nomw non wewen nge esor imwer, ekkewe ra su seni imwer, ika ekkewe chóón ew fénu ra tufich aninis ren mongo ese kamé.Ika pwe ese mo wor a erenuk pwe noum kewe repwe angai aner kewe mongo esapw kamé, kose mochen kékké ika e-mail[school, homeless liaison or migrant coordinator information] omw kopwe sine ika ir mi tufichin angei ei pwekin aninis.
  2. IO A TONGENI EPWE KEKISINÓ NIWIN ANAN MONGO? Noumw kewe semiriit ra tongeni angei aner epwe kukkun niwinin ika pwe an chóón ewe iimw moni tonong a nomw non ewe aukuukun niwin a affat non ewe chepenin moni tonong a tufichi aninis a nomw won ei taropwe apininkeison.
  3. UPWE PWAN CHIWEN AMASOWA ECHÉ APINIKEISON IKA PWE MI TORIEI ECHÉ TAROPWEN SENI EI SUKUUN A ERA PWE NEI KEWE SEMIRIIT RA KETIW REN ANINISIN MONGO AN ESAPW?Kose mochen aneani fichi ewe taropwe ka angeime fiti met e era kopwe fééri.Kékkéri ewe sukuun won[phone number] ika mi wor omw kapas eis.
  4. NOUN NEI WE APINIKEISON A FEN KETIW NON EWE IER A NÓ.UPWE PWAN CHIWEN AMASOWA PWAN ECHÉ?Ewer. Noun noumw we apinikeison a chok ééchu ngeni non ena ierin sukuun me ekkóóch ranin ei ierin sukuun.Kopwe tinanong eché minaféén apinikeisin chilon chok ika ewe sukuun epwe erenuk pwe noum we ese tufichin aninis non ei ierin sukuun.
  5. NGANG MI NOUNOU WIC.NEI WE MI TONGENI ANGEI ANAN MONGO ESAPW KAMÉ? Semiriit non ekkewe iimw ir mi nounouWIC ra tongeni tufich ngeni ekkewe mongo ese kamé ika mi kekis niwinin.Kose mochen amasowa Kose mochen amasowa eché apinikeison.
  6. ekkewe pworaus uwa awora kopwe pwan cheki?Ewer sa pwan tongeni tungoreok om kopwe tinato taropwe anetatá.
  7. IKA PWE USE TUFICHIN ANINIS, NGANG MI PWAN TONGENI TUNGOR MWIRIN?Ewer, ka tongeni tungor (apply) ese nifinifin fansoun nge non chok ena ierin sukuun.Awewe, semiriit ekkewe iner me semer ika chóón tumunur rese chiwen angang ra tongeni tufich ngei ei aninisin mongo an esapw kamé ika epwe kekis niwinin ika pwe moni tonong non ewe iimw epwe turutiw fan ewe éukukun moni tonong.
  8. NGEF IKA USE TIPEEW NGENI AN EWE SUKUUN FINATÁ IKA KAPUNG FAN ITEN NEI WEAPINIKEISON?Kopwe pworaus ngeni ekkewe chóón angangen ewe sukuun. Ka pwan tongeni tungor ew arongorong ka tongeni kékk’e ika mmak ngeni: [name, address, phone number, e-mail].
  9. ngang mi tongeni tungor (apply) ika emon chóón non imwei we esapw emon chóón Merika?Ewer. En ika noum we(kewe) ouse pwan need oupwe chóón Merika ren ami oupwe tufich ngeni ekkei aninisin mongo ese kamé me mi kekis niwinin.
  10. IO IPWE TONGENI APACHANONG PWE CHÓÓN NON IMWEI WE? Kopwe apachanong meinisn aramas ir mi nomw non imwomw we, aramasom ika esapw (pachenong mama me papa chi, ekkóóch aramasom, ika chiechiom)ekkewe ouwa eaea fengen moni tongon me moni ka kamé won. Kopwe apachonong pwisin en me meinisin ekkewe semiriit ra nomw remw.Ika ke nomw ren ekkóóch ekkewe mi pwisin wor ar moni tonong, (awewe, aramas kese anisiir, ouse pwan nounou fengen moni me noum kewe semiriit, me ra mééni wiser ewe mi affat), kosapw pwan apacherenong.
  11. NGE IKA AI MONI TONGON ESE NÉNNÉNÓ ITEITAN FANSOUN MEINISIN?Makkeitiw ukukun met ka kan angei. Awewe, ika ke kan angei$1000 non ew maram, nge ke etiwanó ekkóóch ranin angang non ewe maram a no nge ka chok angei$900, makkeitiw pwe ka kan angei$1000 non ew maram.Ika ekan soun napenó noumw awa seni aukukun awan angang (overtime), apachanong, nge kosapw apachanong ika ke kan chok overtime fan ekkóóch.Ika a pout sonuk omw we angang ika a fen kekisinó noum awa ika niwinum, iwe kopwe chok eaea omw we moni tonong iei.
  12. AM MI NOMW NON SOUNFIU.AUPWE PWAN A PACHANONG NOUM MONIAN IIMW PWE AM MONI TONONG?Ika en mi angei monian omw kopwe nomw nukun ewe nenien sounfiu, epwe pwan kapachenong pwe omw moni tonong. Nge, ika pwe imwomw seni ewe kinikinin aninisin iimw ngeni,kosapw apachanong monian imwomw we pwe ew moni tonong.
  13. IKA PUNUWEI WE A TITINÓ NGENI NENIEN MAUN. NIWININ NE MAUN EPWE PWAN ANEA PWE EW MONI TONONG?Apw, ika pwe niwinin we ne maun a angei fengen me niwinin pwokiten an we titinó ngeni maun me ese angei me mwen an we titinó ngeni maun, niwinin we ne maun esapw anea pwe ew moni tonong.Kééri omw we sukuun ren pwan ekkóóch pworaus.
  14. AI EI FAMINI MI MOCHEN PWAN EKKÓÓCH ANINIS. MI WOR PWAN EKKÓÓCH PROKRAM AUPWE TONGEI TUNGOR (APPLY)? Omw kopwe sine ifa usun kopwe tungor ewe[StateSNAP] ika pwan ekkóóch aninis, kééri ewe ofes non neniomw we kééri[State hotline number].

Ika mi wor ekkóóch pwan ami kapas eis ika ke mochen aninis, kééri[phone number].

Si necesita ayuda, por favor llame al teléfono: [phone number].

Si vous voudriez d’aide, contactez nous au numero: [phone number].

Sincerely,

[signature]

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun

Taropwe ngeni chóón ewe iimw

Peich 1/ 2

July 2011 – Chuukese

Ifa usun omw kopwe tungor (apply)

Chóón non ewe iimw a pachenong semiriit ika mi watte ra nomw remwA.

Ika chóón non imwomw we ir mi angei ar aninis seni[StateSNAP], ika[StateTANF][or the Food distribution program on indian reservations (FDPIR)], fiti ekkei:

Kinikin 1: Etetenatiw meinisin chóón non iimw me itan ewe sukuun emon me emon ekkewe semiriit a fiti.

Kinikin 2:Etetenatiw nampan an emon me emon ekkewe chóchón non ewe iimw (kapachenong mi watte) keis ekkewe ra nounou ekkewe aninis ren[StateSNAP] ika[StateTANF] ika[FDPIR].

Kinikin 3: Amwmwet seni ei kinikin.

Kinikin 4:Amwmwet seni ei kinikin.

Kinikin 5: Saini ei taropwe. Ekkewe ruanu násinóón nampan noum we soson sikiuriti kosapw pwan awora.

Kinikin 6:Kopwe pwisin finata omw pénueni ei kapas eis.

ika ese wor emon me non imwomw we a nounou/eaea[State SNAP] ika[State TANF] aninis ME IKA EMON SEMIRIIT NON IMWOMW WE ESE WOR IMWAN, II CHÓÓN EW FÉNU IKA E SU SENI IMWAN, KOPWE FITI EKKEI MI TETENITIW:

Kinikin 1:Etetenatiw meinsin chóón non imwomwkewe me iten ewe sukuun an emon me emon ekkewe semiriit.

Kinikin 2:Amwmwet seni ei kinikin.

Kinikin 3: Ika pwe emon ekkewe semiriit ka tungor fan itan esor imwan, a feito seni ew fénu, ika su seni imwan cheki ewe pwór ren ewe a weneiti me kékkéri[your school, homeless liaison, migrant coordinator].

Kinikin 4:Awesano ne amasowa chok ika ewe semiriit non imwomw we ese tufichin aninis fan nurun Kinikin 3. Nengeni pworausan met kopwe fééri ren meinisin chóón non ewe iimw.

Kinikin 5: Saini ewe taropwe. Ekkewe nássin nampan sooson sekiuriti kese pwan awora ika pwe kosapw amasowa Kinikin 4.

Kinikin 6:Kopwe pwisin finata omw pénueni ei kapas eis.

IKA KOPWE TUNGOR ANINIS FAN ITAN EMON SEMIRIIT A NOMW FAN NEMENIEN MWUUN, FÉÉRI EKKEI METTÓÓCH A AFFAT FAN:

Ikameinisin semiriit non ewe iimw ir semiriit mi nomw fan nemenien mwuun:

Kinikin 1:Etetenatiw meinisin semiriit mi nomw fan nemenien mwuun me itan ewe sukuun an emon me emon ekkewe semiriit.Chekiewe pwór omw kopwe affata ika ewe semiriit ii emon semiriit mi nomw fan nemenien mwuun.

Kinikin 2:Amwmwet seni ei kinikin.

Part 3: Amwmwet seni ei kinikin.

Part 4:Amwmwet seni ei kinikin.

Part 5:Saini ei taropwe. Ekkewe ruanu násinóón nampan noum we soson sikiuriti kosapw pwan awora.

Part 6 Kopwe pwisin finata omw pénueni ei kapas eis.

Ika ekkóóch ekkei semiriit non ewe iimw ir semiriit mi nomw fan nemenien mwuun:

Kinikin 1:Etetenatiw meinsin chóón ewe iim me itan an emon me emon semiriit sukuun.Ren ese nifinifin aramas, pachenong semiriit, esewor ar moni tonong, kopwe cheki ewe pwór a mak “No Income”.Cheki ewe pwór ika ewe semiriit emon mi nomw fan nemenien mwuun.

Kinikin 2: Ika pwe imwomw we ese wor nampan an keis, amwmwet seni ei kinikin.

Kinikin 3: Ika pwe emon ekkewe semiriit ka tungor aninis fan itan ese wor imwan, ii a feito seni ew fénu, ika e su seni imwan ka cheki ewe pwór a weneiti ika kééri[your school, homeless liaison, migrant coordinator].Ika aapw, amwmwet seni ei kinikin.

Kinikin 4:Fiti met ei taropwe a era ren omw kopwe repotuni kapachanapen moni tonong seni ei maram ika ewe maram a nó.

  • Pwór 1–Itan: Etetenatiw meinisin chóón non ewe iimw fengen me ar moni tonong.
  • Pwór 2 –Ukukun moni tonong mwen takesis me fan fite ka angei:Ren emon me emon chóón non ewe iimw, etetenatiw ew me ew sokkun moni tonong a angei non ew maram. Kopwe ereni kich fan fite ka angei ewe moni—iteitan wiik, iteitan mwirin ruu wiik, fan ruu non ew maram ika non ew maram.Ren niwin, kopwe makkeitiw moni tonong mwen takesis, esapw niwinum we ka uwanó neimw. Gross income iei ewe aukukun ka angei mwen epwe tou takesis me pwan ekkóóch met epwe katou me non niwinum. Ka tongeni kun ei me won risiten niwinum we ika noum we pwos a tongeni erenuk. Ren pwan ekkóóch moni tonong, makkei me etetenatiw ukukun met emon me emon aramas mi angei seni wenfer, aninisin semiriit (child support), moni emon mi pupunu epwe méni ngeni ewe emon fansoun ra mwu fesen mi affat me non kapwung (alimony),moni ka angei fansoun ka ritaer seni omw angang ewe a kawor seni omw angang (pensions), monien ritaer, sooson sekiuriti, Supplemental Security Income (SSI), aninis seni pekin sounfiu (VA benefits), ika aninisin mi ter. Fan Meinisin Pwan Pekin Moni Tonong (all other income), makkeitiw aninisin chóón angang ika repwe feiengaw non angang, aninisin ekkewe ese chiwen wor ar angang (unemployment) ika aninisin fansoun an chóón angang kounó ne angang (strike), aninis seni aramas rese nomw non imwomw we me pwan ekkóóch moni. Kosapw apachanong moni tonong seni SNAP, FDPIR, WIC, aninisin sukuun seni mwuun Merika ika niwin tumwunun ekkewe semiriit mei nomw fan nemenien mwuun ekkewe famini ra angei seni ekkewe ofes ra anenia (ekkei semiriit).Ren CHOK ekkewe ra pwisin anganga ar pisinis, fan eweEarnings from Work, repwotuni moni tonong mwirin moni kopwe kamé won. Iei fan itan omw we pisinis, atake, ika iimwen rent.Ika en mi nomw non Military Privatized Housing Initiative ika peiof seni pekin maun, kosapw apachanong ekkei moni non omw we moni tonong.

Kinikin 5:Ekkewe chóón non ewe iimw mi watte repwe saini ei taropwe me makkeitiw ekkewe ruanu nampan nesopun nour kewe sooson (ika makkei ewe pwór ika ese wor neun)

Kinikin 6:Kopwe pwisin finata omw pénueni ei kapas eis.

MEINISIN PWAN EKKEWE CHÓÓN NON EWE IIMW, pachenong ekkewe ra nounou wic, fiti/fééri ekkei mi tetenitiw:

Kinikin 1:Makkei/etetenatiw meinsin chóón ewe iimw me itan ewe sukuun an emon me emon ekkewe semiriit. Ren ese nifinifin aramas, kapachenong semiriit, ese wor ar moni tonong, kopwe cheki ewe pwór “No Income”.

Kinikin 2:Ika ese wor nampan an chóón ewe iimw keis, amwmwet seni ei kinikin.

Part 3: Ika emon nein ekkewe semiriit ka tungor aninis fan itan ese wor imwan, ii a feito seni pwan ew fénu, ika a su seni imwan cheki ewe pwór a weneiti me kééri[your school, homeless liaison, migrant coordinator].Ika esapw, amwmwet seni ei kinikin.

Kinikin 4: fiti/fééri met ekkei a affat fan omw kopwe repwotuni kapachanapen moni tonong an chóón non ewe iimw non ei maram ika ewe maram a nó.

  • Pwór1–Iit Makkeitiw meinsin chóón ewe iimw mi wor ar moni tonong.
  • Pwór 2 –Ukukun moni tonong mwen takesis me fan fite ka angei: Ren emon me emon chóón non ewe iimw, etetenatiw ew me ew sokkun moni tonong a angei non ew maram. Kopwe ereni kich fan fite ka angei ewe moni—iteitan wiik, iteitan mwirin ruu wiik, fan ruu non ew maram ika non ew maram.Ren niwin, kopwe makkeitiw moni tonong mwen takesis, esapw niwinum we ka uwanó neimw. Gross income iei ewe aukukun ka angei mwen epwe tou takesis me pwan ekkóóch met epwe katou me non niwinum. Ka tongeni kun ei me won risiten niwinum we ika noum we pwos a tongeni erenuk. Ren pwan ekkóóch moni tonong, makkei me etetenatiw ukukun met emon me emon aramas mi angei seni wenfer, aninisin semiriit (child support), moni emon mi pupunu epwe méni ngeni ewe emon fansoun ra mwu fesen mi affat me non kapwung (alimony), moni ka angei fansoun ka ritaer seni omw angang ewe a kawor seni omw angang (pensions), monien ritaer, sooson sekiuriti, Supplemental Security Income (SSI), aninis seni pekin sounfiu (VA benefits), ika aninisin mi ter. Fan Meinisin Pwan Pekin Moni Tonong (all other income), makkeitiw aninisin chóón angang ika repwe feiengaw non angang, aninisin ekkewe ese chiwen wor ar angang (unemployment) ika aninisin fansoun an chóón angang kounó ne angang (strike), aninis seni aramas rese nomw non imwomw we me pwan ekkóóch moni. Kosapw apachanong moni tonong seni SNAP, FDPIR, WIC, aninisin sukuun seni mwuun Merika ika niwin tumwunun ekkewe semiriit mei nomw fan nemenien mwuun ekkewe famini ra angei seni ekkewe ofes ra anenia (ekkei semiriit).Ren CHOK ekkewe ra pwisin anganga ar pisinis, fan ewe Earnings from Work, repwotuni moni tonong mwirin moni kopwe kamé won. Iei fan itan omw we pisinis, atake, ika iimwen rent.Ika en mi nomw non Military Privatized Housing Initiative ika peiof seni pekin maun, kosapw apachanong ekkei moni non omw we moni tonong.

Kinikin 5: Ekkewe chóón non ewe iimw mi watte repwe saini ei taropwe me makkeitiw ekkewe ruanu nampan nesopun nour kewe sooson (ika makkei ewe pwór ika ese wor neun)