2015-2016 Prototype Application for Free and Reduced Price School Meals

 Complete one application per household.




Apply online at www.abcdefgh.edu


List All Household Members who are infants, children, and students up to and including grade 12

Definition of Household Member : " Anyone who is living with you and shares income and expenses even if not related."
Children in Foster care and children who meat the defination of Homeless, Migrant of Runaway are eligible for free meals. Read how to Applu for Free and Reduced Price School Meals for more information.

Yes
No
Yes
No
Yes
No
Yes
No










Do any Household Members (including you) currently participate in one or more of the following assitance programs: SNAP, TANF, of FDPIR   Yes   No
If you answered NO > Complete STEP 3.
If you answered Yes > Write a case number here then to to STEP 4 (Do not complete STEP 3)
Case Number :



Report Income for All Household Members (Skip this step if you answered 'Yes' to STEP 2)

Please read How to Apply for Free and Reduced Price School Meals for more information. The Sources of Income for Children section will help you with the Child Income question. The Sources of income for Adults. section will help you with the All Adult Household Members section.

A. Child Income
Sometimes children in the household earn income. Please include the TOTAL income earned by all Household Members listed in STEP 1 here.
Weekly
BiWeekly
2xMonth
Monthly

B. All Adult Household Members(including yourself)
List all Household Members not listed in STEP 1 (including yourself) eve if they do not receive income. For each Household Member listed. if they do receive income, report total income for each source in whole dollars only, if they do not receive income from any source write '0' if you enter '0' or leave any fields blank, you are certifying (promising) that there is no income to report.










Total Household Members (Children and Adults)
Last Four Digits of Social Security Number (SSN) of Primary Wage Earner or Other Adult Household Member
Check if no SSN



Contant information and adult signature