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Income Eligibility Guidelines (Editable Version)

These scales are published each year by the federal government and must be used to determine eligibility for free and reduced price meals for the effective dates prescribed.

II Annual News Release - Public Announcement (Editable Version)

IIa Available in Spanish (Editable Version)

Prior to the beginning of the school year this release, along with the income eligibility scales for both free and reduced price meals, must be provided to the local news media, the local unemployment office, and to any major employers contemplating large layoffs in the area.

IIb 2021-2022 School Year Public Announcement for School Meals Seamless Summer Option (SSO) of the NSLP (Editable Version)

Prior to the beginning of the school year, this release must be provided to the local news media, the local unemployment office, and to any major employers contemplating large layoffs in the area.

Certification of Acceptance

III For Districts and Nonpublic Schools (Editable Version)

IV For Residential Child Care Institutions (RCCIs) (Editable Version)

The Certification of Acceptance must be completed on the Child Nutrition Management System (CNMS) through the annual renewal process prior to the start of the school year.

Va Application for Free and Reduced Price School Meals/Milk (Editable Version)

Vb Available in Spanish (Editable Version)

Vc Available in Other Languages

Along with the parent letter (Attachment VII), the family application (Attachment Va) must be distributed to all parents of children in attendance at school at the beginning of the school year and for new students when entering during the school year. Each family should complete only one application for their household.

VI Free and Reduced Price Application Fact Sheet (Editable Version)

VIa Available in Spanish (Editable Version)

At the option of the SFA, this fact sheet may be sent home with the application or made available at the school.

VII Parent Letter: School Meal Programs (Editable Version)

VIII Available in Spanish (Editable Version)

Prototype letter that must be sent to parents each year announcing the availability of the Child Nutrition Programs. Only the Reduced Price eligibility scale from Attachment I is included in the breakfast/lunch parent letter. The prototype parent letters included in this packet contain the appropriate scales for the 2019-2020 school year.

IX Parent Letters: Special Milk (Editable Version)

IXa Available in Spanish (Editable Version)

Those schools which sponsor the Special (Free) Milk program may adapt the Special Milk parent letter accordingly. Include only the free income eligibility scale from Attachment I when preparing the Special Milk parent letter.

Notification Letter (Editable Version)

Xa Available in Spanish (Editable Version)

All parents who submit applications must be informed of the approval or denial of such applications. Written notification must be provided to each family denied program benefits in order to provide the family with the hearing and appeals process and a copy of such written notification must be retained on file.

XI Notification Letter to Parents from Direct Cert Matching Process (Editable Version)

XII Available in Spanish (Editable Version)

Notification must be provided to households with children directly certified through the DCMP, letter method or through contacts with officials, such as the SFA’s homeless liaison or a foster care agency.

XIII Parent Letter - Children with Disabilities (Editable Version)

XIIIa Available in Spanish (Editable Version)

XIV Parent Guardian Consent Forms to Release Eligibility Information for Free and Reduced Meals or Free Milk (Editable Version)

XIVa Parent/Guardian Consent Letter in Spanish (Editable Version)

XVa Parent/Guardian Consent Statement (Single Program) in Spanish (Editable Version)

XVIa Parent/Guardian Consent Statement (Multiple Programs) in Spanish (Editable Version)


Last updated
August 2, 2021

USDA Nondiscrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at:, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

  1. mail:
    U.S. Department of Agriculture
    Office of the Assistant Secretary for Civil Rights
    1400 Independence Avenue, SW
    Washington, D.C. 20250-9410; or
  2. fax:
    (833) 256-1665 or (202) 690-7442; or
  3. email:


This institution is an equal opportunity provider.

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