HOWTOAPPLYFORFREEANDREDUCED PRICESCHOOLMEALS

Pleaseuse these instructionstohelp you fillout theapplicationforfreeor reduced priceschoolmeals. You only needtosubmitoneapplicationperhousehold,evenifyour children attend morethan one school in the Cottonwood School District.The application mustbe filledoutcompletelytocertifyyour children forfreeor reduced priceschoolmeals.

Pleasefollowthese instructionsin order!Eachstepofthe instructionsisthesameas thestepson your application.Ifatanytimeyou arenotsure whattodo next, pleasecontactLynn Rehder at 20-8-962-3971.

PLEASE USEAPEN(NOT APENCIL)WHENFILLINGOUTTHE APPLICATIONANDDOYOURBEST TOPRINTCLEARLY.

STEP1:LISTALLHOUSEHOLD MEMBERSWHOAREINFANTS,CHILDREN,ANDSTUDENTS UPTO ANDINCLUDINGGRADE12

Tellus howmany infants, children,andschoolstudents live in your household.They do NOThave tobe relatedtoyou tobe a part ofyour household.

Who should I listhere?

Whenfillingout thissection,please includeallmembersin your household whoare:

Childrenage 18or under andare supportedwiththe household’s income;

In your careunderafosterarrangement,or qualifyashomeless,migrant,or runaway youth;

Studentsattending Cottonwood School Districtregardlessofage.

A)Listeach child’sname.For eachchild,printtheirfirstname,middleinitial andlastname.Useone lineoftheapplicationforeachchild.When printingnames,writeone letterin each box.Stop ifyou run outofspace.If therearemorechildren presentthan linesonthe application,attach asecondpieceof paperwithallrequired informationfortheadditionalchildren.

B)Isthechild astudentat[nameof school/schoolsystemhere]?Mark ‘Yes’or ‘No’under the

column titled“Student”to tellus whichchildren attendwhich school.

C)Doyouhaveany fosterchildren?If anychildren listed are foster children, markthe “Foster Child” box next to the child’s name.Fosterchildrenwho live withyoumay count asmembersofyour householdandshouldbe listedonyour application.Ifyou areonly applying forfosterchildren,after completingSTEP 1,skip toSTEP4ofthe application andthese instructions.

D)Areanychildrenhomeless,migrant,or runaway? Ifyou believeanychildlistedin thissection maymeetthisdescription,pleasemark the “Homeless,Migrant, Runaway”boxnext to the child’s name andcompleteallstepsofthe application.

STEP2:DOANYHOUSEHOLD MEMBERS(INCLUDINGYOU)CURRENTLYPARTICIPATEIN ONEOR MORE OFTHEFOLLOWINGASSISTANCEPROGRAMS:SNAP,TAFI,ORFDPIR?

If anyonein yourhousehold participatesinthe assistanceprograms listed below,your childrenareeligibleforfreeschoolmeals:

The SupplementalNutritionAssistanceProgram (SNAP)

TemporaryAssistanceforFamilies in Idaho(TAFI)

The FoodDistributionProgramonIndian Reservations (FDPIR)

A)IFNOONEINYOURHOUSEHOLDPARTICIPATES INANYOFTHE ABOVELISTEDPROGRAMS:

Circle‘NO’andskip toSTEP3onthese instructions andSTEP3onyour application.

LeaveSTEP2blank.

B)IFANYONEINYOURHOUSEHOLDPARTICIPATESINANYOFTHE ABOVELISTEDPROGRAMS:

Circle‘YES’andprovideacasenumber for SNAP, TAFI,or FDPIR. You only needto write

onecasenumber.Ifyou participatein one oftheseprogramsand donotknowyour case number, contact:[State/localagency contactshere].Youmustprovidea case numberonyour applicationifyou circled“YES”.

SkiptoSTEP4.

STEP3:REPORTINCOMEFORALLHOUSEHOLDMEMBERS

A)Reportallincome earnedby children.Refertothecharttitled“Sources of Income for Children” in these instructionsand reportthecombined gross incomefor ALLchildren listedin Step 1inyour householdinthe boxmarked“Total Child Income.”Onlycountfoster children’s income if you are applying forthemtogetherwiththerestofyour household.Itisoptionalforthe household to listfoster children livingwiththem as partofthehousehold.

Whatis Child Income?

Childincomeis moneyreceived fromoutside yourhouseholdthat ispaid directlyto yourchildren.Many householdsdo not haveany childincome.Use thechart below to determineif yourhouseholdhas childincometo report.

SourcesofIncomeforChildren
SourcesofChildIncome / Example(s)
Earningsfromwork / A child has ajobwherethey earnasalary or wages.
SocialSecurity
oDisabilityPayments
oSurvivor’s Benefits / A child isblind or disabledandreceives
SocialSecuritybenefits.
A parentisdisabled,retired,or deceased, andtheirchild receivessocialsecurity
benefits.
Incomefrompersonsoutsidethehousehold / A friendorextended familymember
regularlygivesachild spending money.
Incomefromanyothersource / A child receivesincomefromaprivate pension fund, annuity,or trust.

FOREACHADULT HOUSEHOLDMEMBER:

Who should I listhere?

Whenfillingout thissection,please includeallmembersin your household whoare:

Livingwithyou andshareincome andexpenses,even ifnotrelated andeven iftheydo not receiveincomeoftheirown.

Donotincludepeople who:

Live with you butare notsupportedby yourhousehold’s incomeanddo notcontribute income toyour household.

Childrenandstudentsalready listedin Step 1

How do I fillin theincome amountand source?

FOREACHTYPEOFINCOME:

Use thecharts in thissectiontodetermineifyour householdhas incometoreport.

ReportallamountsingrossincomeONLY.Reportallincome in wholedollars.Donot includecents.

oGrossincome is the totalincomereceivedbeforetaxesor deductions.

oManypeople thinkof income as the amount they“takehome” andnot the total,

“gross” amount. Make surethat the income you reportonthis application has

NOTbeenreducedtopayfortaxes,insurancepremiums,or anyotheramounts taken fromyour pay.

Write a“0” in anyfields where there is no income to report.Anyincomefieldsleftemptyor blank willbe counted as zeroes.If you write ‘0’or leaveanyfields blank,you are certifying (promising)thatthereisno income toreport. If localofficialshave knownor available informationthatyour household income wasreportedincorrectly,your application willbe verifiedforcause.

Mark howofteneachtypeof income isreceivedusingthecheckboxes to therightofeach field.

B)List Adult Householdmember’s name.Printthenameof eachhouseholdmemberin theboxes marked“Names of AdultHouseholdMembers (FirstandLast).”Donot listany householdmembersyou listedinSTEP 1.If achild listedin STEP1 has income,followthe instructionsin STEP 3, partA.

C)Reportearnings fromwork.Refer to the charttitled“Sources of Income for Adults” inthese instructionsandreportallincomefromworkin the “Earnings fromWork”fieldon theapplication.This is usually themoneyreceivedfromworkingatjobs.Ifyouareaself-employedbusiness or farmowner,you willreportyour netincome.

Whatif I am self-employed?

Ifyou areself-employed,report incomefromthat work as anetamount. This is calculated by subtractingthetotaloperatingexpenses of your businessfromits gross receipts orrevenue.

D)ReportincomefromPublic Assistance/ChildSupport/Alimony.Refer to thecharttitled“Sources of Incomefor Adults” inthese instructionsandreportallincome thatappliesinthe “Public Assistance/Child Support/Alimony” fieldonthe application.Donotreportthevalueofanycashvalue publicassistancebenefits NOTlistedonthechart.If income isreceivedfromchild supportor alimony, only court-orderedpaymentsshould be reportedhere.Informalbutregularpaymentsshould be reported as “other” income inthe nextpart.

E)ReportincomefromPensions/Retirement/Allother income.Referto thechart titled“Sources of Income forAdults” inthese instructionsandreportallincome thatapplies in the “Pensions/Retirement/AllOther Income” fieldontheapplication.

F)Reporttotalhouseholdsize.Enterthe totalnumberofhouseholdmembersin thefield“Total HouseholdMembers(ChildrenandAdults).”ThisnumberMUSTbe equalto the numberofhousehold memberslistedin STEP1 and STEP3.If thereareanymembersofyour householdthatyou havenot listedontheapplication,go backandaddthem.Itisveryimportantto listallhouseholdmembers,as the sizeofyour householddeterminesyour incomecutoff forfreeandreducedprice meals.

G)Provide the lastfourdigitsof your Social SecurityNumber. The household’s primarywage earner or anotheradulthouseholdmembermustenter the lastfour digitsof theirSocialSecurityNumberin the space provided.You areeligibleto apply forbenefitsevenifyou do nothave aSocialSecurity Number.Ifno adulthouseholdmembershave aSocialSecurityNumber,leave thisspace blank andmark the box to the right labeled“Checkif no SS#.”

SourcesofIncomeforAdults
EarningsfromWork / PublicAssistance/Alimony/ ChildSupport / Pensions/Retirement/AllOther
Income
Salary,wages,cash bonuses
Netincomefromself- employment(farmor
business)
Strikebenefits
Ifyou areinthe U.S.Military:
Basicpayandcash bonuses (doNOTinclude
combatpay,FSSA or privatizedhousing allowances)
Allowancesforoff-base housing,food,and
clothing / Unemploymentbenefits
Worker’s compensation
SupplementalSecurity
Income(SSI)
Cash assistancefrom
Stateor localgovernment
Alimonypayments
Childsupportpayments
Veteran’sbenefits / SocialSecurity(including railroadretirementand
black lungbenefits)
PrivatePensionsor disability
Incomefromtrustsor estates
Annuities
Investmentincome
Earnedinterest
Rentalincome
Regularcashpayments fromoutsidehousehold

STEP 4:CONTACTINFORMATIONANDADULTSIGNATURE

Allapplicationsmustbe signedby anadultmember ofthehousehold.By signing theapplication, thathouseholdmemberispromisingthat allinformationhasbeentruthfullyandcompletelyreported. Beforecompletingthissection,pleasealsomake sure you have readtheprivacyand civilrights statementsontheback oftheapplication.

A)Provideyour contact information.Writeyour currentaddress in thefieldsprovidedif this informationisavailable.Ifyou have no permanentaddress,thisdoes notmake yourchildren ineligibleforfreeor reducedpriceschoolmeals.Sharing aphone number,emailaddress,or both is optional,buthelpsus reach you quickly if weneedtocontactyou.

B)Signand printyour name.Printyour nameinthe box “Printednameofadultcompletingtheform.”

Andsignyour namein thebox “Signature of adultcompletingthe form.”

C)Write Today’s Date.In thespace provided,writetoday’s date inthebox.

D)Sharechildren’s RacialandEthnicIdentities(optional).Onthebackoftheapplication,weask you to share information aboutyour children’s raceandethnicity.This fieldisoptionalanddoesnot affect your children’seligibility forfreeorreducedpriceschoolmeals.