Dear Parent/Guardian:
Children need healthy meals to learn. Fentress County School System offers healthy meals every school day. Breakfast costs. 60; lunch costs. 90. Your children may qualify for free meals or for reduced price meals. Reduced price is .30 for breakfast and.40 for lunch.
1. Do I need to fill out an application for each child? No. Complete the application to apply for free or reduced price meals. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is' not complete, so be sure to fill out all required information. Return the completed application to your school.
2. Who can get free meals? Children in households getting Food Stamps or FAMILIES FIRST and most foster children can get free meals regardless of your income. Also, your children can get free price meals if your household income is within the free limits on the Federal Income Guidelines.
3. Can homeless, runaway and migrant children get free meals? Please call Tammy Criswell at 931/879-8341 to see if your child(ren) qualify, if you have not been informed that they will get free meals. 4. Who can get reduced price meals? Your children can get low cost meals if your household income is within the reduced price limits on the Federal Income Chart, shown on this application.
5. Should I fill out an application if I got a letter this school year saying my children are approved for free or reduced price meals? Please read the letter you got carefully and follow the instructions. Call the school at if you have questions.
6. I get WlC. Can my child(ren) get free meals? Children in households participating in WIC may be eligible for free or reduced price meals. Please fill out an application.
7. Will the information I give be checked? Yes, we may ask you to send written proof.
8. If I don't qualify now, may I apply later? Yes. You may apply at any time during the school year if your household size goes up, income goes down, or if you start getting Food Stamps, FAMILIES FIRST or other benefits. If you lose your job, your children may be able to get free or reduced price meals.
9. What if I disagree with the school's decision about my application? You should talk to school officials. You also may ask for a hearing by calling or writing to: Fentress County Board of Education Tammy Criswell P. O. Box 963 Jamestown, TN 38556 931/879-8341.
10. May I apply if someone in my household is not a U.S. citizen? Yes. You or your child(ren) do not have to be a U.S. citizen to qualify for free or reduced price meals.
11. Who should I include as members of my household? You must include all people living in your household, related or not (such as grandparents, other relatives, or friends). You must include yourself and all children who live with you.
12. What if my income is not always the same? List the amount that you normally get. For example, if you normally get $1000 each month, but you missed some work last month and only got $900, put down that you get $1000 per month. If you normally get overtime, include it, but not if you get it only sometimes. 13. We are in the military, do we include our housing allowance as income? If your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. All other allowances must be included in your gross income.

If you have other questions or need help, call 931/879-8341.
Si necesifa ayuda, par favor /lame al felMono: 931/879-8341.
Si vous voudriez d'aide, confactez nous au numero: 931/879-8341.

Sincerely, Tammy Criswell



FEDERAL INCOME CHART For School Year 2005 - 2006

Household Size	Yearly	Monthly	Weekly
1	17,705	1,476	341
2	23,736	1,978	457
3	29,767	2,481	573
4	35,798	2,984	689
5	41,829	3,486	805
6	47,860	3,989	921
7	53,891	4,491	1,037
8	59,922	4,994	1,153
Each additional person:	6,031	503	116

Your children may qualify for free or reduced price meals if your household income falls within the limits on this chart.

Privacy Act Statement: This explains how we will use the information you give us.
The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the social security number of the adult household member who signs the application. The social security number is not required when you apply on behalf of a foster child or you list a Food Stamp Program, Families First Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.

Non-discrimination Statement: This explains what to do if you believe you have been treated unfairly.
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, Room 326- W, Whitten Building, 1400 Independence A venue, SW, Washington DC 20250-9410 or call 202-720-5964 (voice and TOO). USDA is an equal opportunity provider and employer.



INSTRUCTIONS FOR APPLYING
If your household gets FOOD STAMPS OR FAMILIES FIRST, follow these instructions:
Part 1: List child(ren)'s name, school, grade, and a Food Stamp or FAMILIES FIRST case number. Part 2: Check the appropriate box, if any.
Part 3: Skip this part.
Part 4: Skip this part.
Part 5: Sign the form. A Social Security Number is not necessary.
Part 6: Answer this question if you choose to.
If the child(ren) your are applying for is (are) homeless, migrant, or runaway contact [your school, homeless liaison, migrant coordinator].
Fill out the application by following the instructions for All OTHER HOUSEHOLDS.
If you are applying for a FOSTER CHilD, follow these instructions:
Part 1: Use a separate application for each foster child. List the child's name, school, and grade. Part 2: Skip this part.
Part 3: Check the box and list the child's personal use monthly income, if any.
Part 4: Skip this part.
Part 5: Sign the form. A Social Security Number is not necessary.
Part 6: Answer this question if you choose to.
All OTHER HOUSEHOLDS (Including WIC, migrant, homeless and runaway households), follow these instructions:
Part 1: List each child's name, school, and grade.
Part 2: Check the appropriate box, if any.
Part 3: Skip this part.
Part 4: Follow these instructions to report total household income from last month.
Column 1-Name: List the first and last name of each person living in your household, related or not (such as grandparents, other relatives, or friends). You must include yourself and all children living with you. Attach another sheet of paper if you need to.
Column 2 -Gross income last month and how often it was received. Next to each person's name list each type of income received last month, and how often it was received. For example, Earnings from work: List the gross income each person earned from work. This is not the same as take-home pay. Gross income is the amount earned before taxes and other deductions. The amount should be listed on your pay stub, or your boss can tell you. Next to the amount. write how often the person Qot it (weekly, every other week, twice a month, or monthly). All other income: List the amount each person got last month from welfare, child support, alimony, (second column) pensions, retirement, Social Security (third column), and ALL OTHER INCOME SOURCES (fourth column). In the All Other column, include Worker's Compensation, unemployment, strike benefits, Supplemental Security Income (SSI), Veteran's benefits 0/A benefits), disability benefits, regular contributions from people who do not live in your household, and ANY OTHER INCOME. Report net income for self-owned business, farm, or rental income. Next to the amount. write how often the person Qot it. If you are in the Military Housing Privatization Initiative do not include this housing allowance.
Column 3-Check if no income: If the person does not have any income, check the box.
Part 5: An adult household member must sign the form and list his or her Social Security Number, or mark the box if he or she doesn't have one.
Part 6: Answer this question if you choose to.



School Food Authority Verification Results

Income and TANF ( Families First) Food Stamp Verification Attachment

If this information is not on your application, complete and attach this to all verified applications

Student Name_____________________________________________________________________________________________

Date Selected For Verification ___________________________ Response Due From Household______________________

Date Second Notice Sent( If applicable):_____________________________________________________________________

DOCUMENTATION

____Food Stamp/TANF(Families First) Eligibily ____Monthly Income

____Not Confirmed ____Income

____Confirmed

____Food Stamp Office ____Wage Stubs

____Notice of Eligibility ____Written Documents

____ATP Card Issued Monthly(Not ID card w/o expiration date) ____Collateral Contract

____Other _______________________________________Specify

VERIFICATION RESULTS

____No Change ____Ineligible____Free to Reduced Price ____Reduced Price to Free

Reason for Eligibility Change: ____High Income____Refused to Cooperate

____Food Stamp/TANF(Families First) Eligibility Not Confirmed

____Other (explain)_________________________________________

Date Advance Notice Sent_____________________________________

SIBLINGS AFFECTED	SCHOOL ATTENDING

Signature of Verifying Offical_________________________________________________________Date________________________________

Other Comments_____________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________




Last Name of Household__________________________________________________________Free______ Reduced______ Paid______

FREE AND REDUCED PRICE SCHOOL MEALS FAMILY APPLICATION