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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.

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)

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)

Parent Guardian Consent Forms to Release Eligibility Information for Free and Reduced Meals or Free Milk

XIV Parent/Guardian Consent Letter (Editable Version)

XIVa Available in Spanish (Editable Version)

XV Parent/Guardian Consent Statement (Single Program) (Editable Version)

XVa Available in Spanish (Editable Version)

XVI Parent/Guardian Consent Statement (Multiple Programs) (Editable Version)

XVIa Available in Spanish (Editable Version)

 

Last updated
June 20, 2019

USDA Nondiscrimination Statement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. 

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter 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;

(2)     fax: (202) 690-7442; or

(3)     email: program.intake@usda.gov.

This institution is an equal opportunity provider.

Los demás programas de asistencia nutricional del FNS, las agencias estatales y locales, y sus beneficiarios secundarios, deben publicar el siguiente Aviso de No Discriminación:

De conformidad con la Ley Federal de Derechos Civiles y los reglamentos y políticas de derechos civiles del Departamento de Agricultura de los EE. UU. (USDA, por sus siglas en ingles), se prohíbe que el USDA, sus agencias, oficinas, empleados e instituciones que participan o administran programas del USDA discriminen sobre la base de raza, color, nacionalidad, sexo, discapacidad, edad, o en represalia o venganza por actividades previas de derechos civiles en algún programa o actividad realizados o financiados por el USDA.

Las personas con discapacidades que necesiten medios alternativos para la comunicación de la información del programa (por ejemplo, sistema Braille, letras grandes, cintas de audio, lenguaje de seas americano, etc.), deben ponerse en contacto con la agencia (estatal o local) en la que solicitaron los beneficios. Las personas sordas, con dificultades de audición o discapacidades del habla pueden comunicarse con el USDA por medio del Federal Relay Service [Servicio Federal de Retransmisión] al (800) 877-8339. Además, la información del programa se puede proporcionar en otros idiomas.

Para presentar una denuncia de discriminación, complete el Formulario de Denuncia de Discriminación del Programa del USDA, (AD-3027) que está disponible en linea en:http://www.ocio.usda.gov/sites/default/files/docs/2012/Spanish_Form_508_Compliant_6_8_12_0.pdf. y en cualquier oficina del USDA, o bien escriba una carta dirigida al USDA e incluya en la carta toda la información solicitada en el formulario. Para solicitar una copia del formulario de denuncia, llame al (866) 632-9992. Haga llegar su formulario lleno o carta al USDA por:

(1)     correo: U.S. Department of Agriculture
         Office of the Assistant Secretary for Civil Rights
         1400 Independence Avenue, SW
         Washington, D.C. 20250-9410;

(2)     fax: (202) 690-7442; o

(3)     correo electrónicoprogram.intake@usda.gov.

Esta institución es un proveedor que ofrece igualdad de oportunidades.

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