# ![](media/image1.png){width="1.0402777777777779in" height="1.2486111111111111in"}Arjiga iyo foomamka cadaynta ee Cuntada iskuulka Qiimaha jaban iyo kan Bilaashka

#  

# sanad dugsiyeedka \_\_\_\_\_-\_\_\_\_\_

# Tilmaan-bixnta loogu tala galey iskuulada degmooyinka 

Warqadahaan waxay ka kooban yahiin:

Macluumaadka **Loo-baahan yahay** in la qaybiyo guryaha:

-   Warqad ku socota guryaha

-   Arjiga cuntada Iskuulka oo qiimaha la dhimay iyo kan cuntada
    bilaashka

Macluumaadka Cadeynta xaq-u-lahaanshaha:

-   Digniinta dalabka cadaynta xaq-u-lahaanshaha

-   Warqad Jawaabaha Cadaynta

Arji **Ikhtiyaar ah** oo la xiriira kuwa loo qaybin doona guryaha:

-   Macluumaadka lala wadaagaayo Medicaid/SCHIP

-   Macluumaadka lala wadaagaayo Barnaamijyadaha kale.

Boggakan waxaa loogu tala galay in lagu daawaco warqada 8½" ilaa iyo 11"
ah. Boggakan qaar waxaa lagu daabaci karaa bogga hore iyo kan dambe.
Waxaad u baahan tahay in aad calaamadayso manaafaacdyada aad ka heli
karto iskuulkaaga, sida cuntada-fudud ee la bixiyo iskuulka marka uu
dhamaado ka dib. **\[Goobaha Farta Waa Weyn ee Goobaabin Ku Jira\]**
Calaamadeey halka aad u baahan tahay in aad geliso macluumadka gaarka ah
ee iskuulka degmada. Tusaale ahaan, waa in aad raacisaa talefoon
nambarkaaga mid aah degmada ah aanaan ahayn nooca lacagta ah marka la
soo waco hadii lagaaga baahdo caawimaad ku saabsan waqradaha cadaymaha.
Warqadahaan hadii aan dib aan loo badalin si loogu daro magaca Gobolka
aad degan tahay ee Caawimaada Ku Meel-Gaarka ee Qosaska Tabarta Yare oo
marka la soo gaabiyo loo yaqaano (TANF), iyo Barnaamijka Caymiska
Caafimaad Caruurta (SCHIP), ama hadii ay jirto, lagu daro Barnaamijka
Qaybista Raashinka ee Deegaamada Indianska (FDPIR), waa in aad
macluumaadka gelisaa goobaha ku haboon. Hadii aad samayso badelaad kale,
waa in aad warqadahaaga codsiga u dirtaa wakaalada Gobolka ee qaabilsan
ogolaashaha.

Warqadahaan arjiga ee qaybtiisa hore waxay ka kooban yihiin macluumaadyo
ku saabsan ka reebida gunnada guryaha ee la siiyo kuwa ku jira Qorshaha
Guriyaha Askarta. Hadii iskuulka degmadaada tani qusaynin, fadlan u
badel sida ku haboon.

Hadii aad hayso su'aalo, la xiir:

**\[State agency address\]**

February 2006 Free and Reduced Price School Meals Application

Somali Version Letter to Households

Page 2 of 3

**\[Insert School District Letterhead\]**

Gacaliye Waalid/Illaaliye:

##### Caruurta waxay u baahan yihiin cunto wanaagsan si ay wax u bartaan. \[Name of School\] Maalin kasta ee iskuul jira wuxuu ardayga ugu deeqaa cunto wanaagsan. Qiimaha quraacda waa \[\$\]; Qiimaha qadada waa \[\$\]; Cunugaaga waxaa laga yaabaa inuu u qalmo cunto lacag la'aan ah ama cunto qiimaheedu jaban jahay. Qiimaha jaban ee quraacda waa \[\$\] qadadana waa \[\$\]. 

**1. Cunug kasta ma arji gaar ah in aan u bixiyaa?** Maya. Dhamaystir
arjiga si aad u codsato cunto qiimo jaban ama bilaash ah. [Isticaal Hal
Arji Kaliya Si Aad ugu Codsato Cuntada Jaban Iyo Cunto Bilaash Dhamaan
Ardayda Guriga Joogta.]{.underline} Ma ogolaan karno arji aan si fiican
u dhamaystirnayn, sidaa darted iska hubi in aad buuxiso macluumaadka
lagaa doonaayo. **Arjiga makaad soo dhamaystirto ku soo celi: \[name,
address, phone number\].**

**2. Yaa la siin karaa cunto bilaash ah?** Caruurta guryahooda la siiyo
Fuud Stambe ama TANF iyo caruurta ay kor sadaan dad aan waalidkooda
ahayn badankooda waxay heli karaan cunto bilaash ah ayadoon la eegayn
lacagta ku soo gasha. Sidoo kale, Caruurtaada waxay heli karaan cunto
bilaash ah hadii daqliga gurigaaga ka yar yahay xadka Daqliga ee ay
Meel-dhigtay Dowlada Sare.

**3. Caruurta aan guryo lahayn, kuwa ka soo cararay guryahooda iyo kuwa
aan u dhalan wadanka ma la heli karaan cunto bilaash ah?** Fadlan wac
**\[school, homeless liaison or migrant coordinator\]** Si aad u ogaato
in cunugaaga u qalmayyo, hadii aan horeyba laguugu soo wargelin in ay
heli doonaan cunto bilaash ah.

**4. Yaa la siin karaa cuntada qiimaheeda hoos loo dhigay?** Caruurtaada
way heli karaan cunta lacag yar hadii daqliga gurigaaga yahay mid u
dhaxeeya xadka uugu tala galay Jadalwalka Daqliga ee Dowlada Sare,
kaasoo lagu muujiyay arjigaan.

**5. Malayga doonayaa in aan arji booxiyo hadii sanad dugsiyeedkan
dhexdiisa aan helay warqad sheegaysa in curuurtayda loo ogolaaday
cuntada lacagta jaban ama cuntada bilaashka ah?** Fadlan warqada aad
heshay si taxadir ku jirta u aqri kadibna raac tilmaamaha. Iskuulka ka
wac nambarka ah **\[phone number\]** Hadii su'aalo aad qabto.

**6. Waxaan qaataa WIC. Caruurtayda ma helayaan cuntada bilaashka ah?**
Caruurta guryaha laga qaato WIC [waxaa laga yaabaa]{.underline} in ay
xaq-u-leeyihiin cuntada qiimaaha lacagteeda la dhimay ama bilaashka ah.

**7. Miyaa la baarayaa macluumaadka aan siiyo?** Haa, Waxaa laga yaabaa
in aan ku weydiino in aad cadayn noo soo dirto. .

**8. Hadii hada aanan u qalmin, mar kale ma codsan karaa?** Haa. Woqti
kasta ayaad dalban kartaa in lagu jiro sanad dugsiyeedka hadii inta
xubin ee qooskaaga ka kooban yahay kordhaan, daqliga reerka hoos u
dhaco, ama aad bilaawdo in lagu siiyo Fuud Stambe, TANF ama
manaafacaadyo kale. Hadii ay shaqadaada kaa joogsatana, caruurtaada
waxaa laga yaabaa in ay helaan cuntada lacagteedu jaban tahay ama
bilaashka ah.

**9. Maxaa sameeyaa hadii aanan ku qanac sanayn go'aanka iskuulka eek u
saabsan arjigayga?** Waa in aad la hadashaa maamulada iskuulka. Sidoo
kale waxaad codsan kartaa in dacwadaada la dhegaysto adigoo wacaya ama
warqad u diraya: **\[name, address, phone number\]**.

February 2006 Free and Reduced Price School Meals Application

Somali Version Letter to Households

Page 2 of 3

**10. Ma dalban karaa hadii gurigayga uu jiro qof aanan haysanin
dhalashada Maraykanka?** Haa. Adiga ama cunugaaga ma aha in aad
haysataan dhalashada Amerikaanka si aad ugu qalantaan cuntada bilaashka
ah ama cuntada lacagteedu la dhimmay.

**11. Qofkee ayaan ku daraa in ay ka mid yihiin xubnaha reerkayga?** Waa
in aad ku dartaa dhamaan xubnaha reerka ku nool, hadii ay kula dhasheen
iyo hadii kale (sida Awoowe iyo Ayeeyo, dadka kale ee kula dhashay, ama
saaxiibada). Waa in aad adigu isku dartaa iyo dhamaan caruurta idin la
degan.

**12. Maxaan sameeyaa hadii daqligeyga mar waliba uusan isku mid
ahayn?** Ku qor lacagta sida caadiga aad hesho. Tusaale ahaan, hadii bil
kasta aad caadi ahaan hesho \$1000, balse bishii hore aad saacado badan
aadan shaqayn iyo \$900 kaliya aad heshay, ku qor in aad shaqada aad
bishiiba ka heshay \$1000. Hadii caadi ahaan saacado dheeraad aad
samayso, taana ku dar, balse haku qorin hadii aad mar mar kaliya aad
hesho.

**13. Ciidamada ayaan ku jirnaa, ma ku darnaa daqliga gunno ahaan noo
soo gasha?** Hadii guryahaaga yahay kuwa qayb Guryaha Askarta qayb ka
yahay, gunnadaada daqli ahaan ha'ugu soo darin. Gunnooyinka kale oo dhan
waa in loogu soo daraa sida daqli jumlo ahaan.

Hadii aad su'aalo kale hayso ama aad caawimaad u baahan tahay, wac
**\[phone number\].**

*Si necesita ayuda, por favor llame al teléfono: **\[phone number\].***

*Si vous voudriez d'aide, contactez nous au numero: **\[phone
number\].***

Daacadnimo,

**\[signature\]**

February 2006 Free and Reduced Price School Meals Application

Somali Version Letter to Households

Page 3 of 3

**TILMAAMAHA SIDA LOO CODSADO**

+-----------------------------------------------------------------------+
| **Hadii gurigaag la siiyo FUUD STAMBE AMA TANF, raac tilmaamooyin     |
| kan:**                                                                |
|                                                                       |
| **Qaybta 1:** Ku qor magaca cunugaaga/caruurtaada, iskuulka, fasalka, |
| iyo nambarka Fuud Stambe aha ama TANF.                                |
|                                                                       |
| **Qaybta 2:** Sanduuqa ku haboon saar calaamada saxda ah, hadii ay    |
| jiraan.                                                               |
|                                                                       |
| **Qaybta 3:** Ka bood qaybtan.                                        |
|                                                                       |
| **Qaybta 4:** Ka bood qaybtan.                                        |
|                                                                       |
| **Qaybta 5:** Foormka saxiix. Nambarka Soshal Sekuuritiga ma aha      |
| muhiim.                                                               |
|                                                                       |
| **Qaybta 6:** Ka jawaab su'aashan hadii aad doorato in aad ka         |
| jawaabto.                                                             |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Sanduuqa ku haboon saar calaamada saxda ah iyo la xiriir \[your     |
| school, homeless liaison, migrant coordinator\].**                    |
|                                                                       |
| **DHAMAAN KUWA KALE EE GURIGA KU NOOL arjiga ku buuxi adigoo raacaya  |
| tilmaamahan.**                                                        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Hadii aad u buuxinayso CUNUG AAD KORSANAYSO, raac                   |
| tilmaamooyinkan:**                                                    |
|                                                                       |
| **Qaybta 1:** **Cunug kasta ee aad korsanaysid isticmaal arji kala    |
| duwan.** Ku qor magaca cunuga, iskuulka, iyo fasalka.                 |
|                                                                       |
| **Qaybta 2:** Ka bood qaybtan.                                        |
|                                                                       |
| **Qaybta 3:** Calaamada saxda ah saar iyo hadii ay jirto qor daqliga  |
| uu cunuga isticmaalo bishiiba.                                        |
|                                                                       |
| **Qaybta 4:** Ka bood qaybtan.                                        |
|                                                                       |
| **Qaybta 5:** Saxiix foormka. Soshal Sekuyriti Nambar ma aha muhiim.  |
|                                                                       |
| **Qaybta 6:** Ka jawaab su'aashan hadii aad doorato in aad ka         |
| jawaabto.                                                             |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **DHAMAAN KUWA KALE GURIGA KU NOOL, oo ay ku jiraan GURIYAHA la siiyo |
| WIC, raac tilmaamooyinkan:**                                          |
|                                                                       |
| **Qaybta 1:** Qor cunug kasta magaciisa, iskuulka, iyo fasalka uu     |
| dhigto.                                                               |
|                                                                       |
| **Qaybta 2:** Sanduuqa ku haboon saar calaamada saxda ah, hadii ay    |
| jiraan.                                                               |
|                                                                       |
| **Qaybta 3:** Ka bood qaybtan.                                        |
|                                                                       |
| **Qaybta 4:** Raac tilmaamooyinkan si aad u warbiso daqliga guriga ee |
| bisha hore isku jir ah.                                               |
|                                                                       |
| > **Sadarka 1--Magaca:** **Qof kasta** oo ku nool guriga ku qor       |
| > magaciisa hore iyo kan dambe, hadii aad wax u tahay iyo hadii kale  |
| > (Waalidiintaada, kuwa kula dhashay, ama saaxiibadaada). Adigana waa |
| > in aad isku qortaa iyo dhamaan caruurta kula degan. Warqad kale ku  |
| > soo qor hadii aad u baahato.                                        |
| >                                                                     |
| > **Sadarka 2** --**Daqliga guud ee bisha hore ku soo galay iyo inta  |
| > jeer daqliga ku soo galo.** Magaca qof kasta dhiniciisa ku qor      |
| > nooca daqli ee uu bisha hore helay, iyo inta jeer ee uu helay.      |
| > Tusaale ahaan, *Daqliga shaqada:* Ku qor qof kasta **daqliga guud** |
| > ee ka soo gala shaqada. Tani la mid ma aha tirada saafiga ah ee aad |
| > guriga la timaado. **Daqliga guud inta canshuurta iyo lacagaha kale |
| > aan laga jarin.** Cadada waxay ku qoran tahay jeega dabadiisa, ama  |
| > waxaa kuu sheegi kara qofka shaqada madax u ah. [Cadada lacagta     |
| > dhankeeda, ku qor inta jeer ee uu qofka la siiyo (usbuuc kasta,     |
| > labada usbuuca mar, bishiiba laba jeer, ama bil kasta)]{.underline} |
| > he amount should be listed on your pay stub, or your boss can tell  |
| > you. *Daqliga kale oo dhan:* Ku qor cadada qof kasta uu helay bisha |
| > hore oo ka soo gashay cayrta, masaruufka canuga, taageero, (safaka  |
| > labaad) lacagta la siiyo qofka howl-gabka, shaqo ka fariista,       |
| > Soshal Sekuyriti (safka sedexaad), iyo DHAMAAN HALKA AY KA          |
| > YIMAADAAN DAQLI KASTA (safka afaraad). Safka ku qoran Dhamaan Kuwa  |
| > Kale, ku dar Lacagta Maga Shaqaalaha, lacagta shaqo la'aanta,       |
| > lacagta shaqo-ka fariisiga, Daqliga Soshal Sekuyritiga la soo       |
| > raaciyo (SSI), lacagta qof ciidamada ku jiray la siiyo (Manvacyada  |
| > VA-ga), lacagta la siiyo qofka curyaanka la siiyo, tabarucaad       |
| > joogta ah ee ay bixiyaan dad aanan ku noolayn guryaha, iyo DAQLI    |
| > KALE OO KASTA. Soo sheeg daqliga cadadka ah ee ka soo gala          |
| > shaqadaada, beeraha, ama lacag ijaar ka soo gasha. [Cadada          |
| > dhinaceeda, ku qor inta jeer qofka uu helo.]{.underline} Hadii aad  |
| > ku jirto Qorshaynta Guryaha Askarta gudda guryaha ha ku darin.      |
| >                                                                     |
| > **Safka 3--Calaamada saxda saar hadii daqli jirin:** Hadii qofka    |
| > uusan haysan wax daqli ah, sanduuqa saar calaamada saxda.           |
|                                                                       |
| **Qaybta 5:** Xubnaha guriga degan ee qaangaarka ah waa in ay         |
| saxiixaan foomka kadibna ku qoraan Soshal Sekuuriti Nambarkooda, ama  |
| sanduuqa calaamade hadii asaga ama ayada aysan la hayn.               |
|                                                                       |
| **Qaybta 6:** Ka jawaab su'aashan hadii aad doorato in aad ka         |
| jawaabto.                                                             |
+-----------------------------------------------------------------------+

February 2006 Free and Reduced Price School Meals Application

Somali Version Application

Page 1 of 4

**ARJIGA QOOSKA EE CUNTADA ISKUULKA EE LACAGTA JABAN IYO CUNTADA
BILAASHKA AH**

+-------------------+---+----------+-----+----+---+----------+----------+---+
| **Qaybta 1.       |   |          |     |    |   |          |          |   |
| Caruurta Iskuulka |   |          |     |    |   |          |          |   |
| dhigata (Arji ka  |   |          |     |    |   |          |          |   |
| duwan u isticmaal |   |          |     |    |   |          |          |   |
| ciyaal kasata ee  |   |          |     |    |   |          |          |   |
| aad korsanaysid   |   |          |     |    |   |          |          |   |
| oo aad dhalin)**  |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| Magaca caruurta   |   | Magaca   |     | F  |   | Kees \#  |          |   |
| iskuulka dhigata  |   | Iskuulka |     | as |   | Fuud     |          |   |
| oo dhan\          |   |          |     | al |   | Stambe   |          |   |
| (Magaca Hore,     |   |          |     | ka |   | ama TANF |          |   |
| Dhaxe, Dambe      |   |          |     |    |   | (hadii   |          |   |
|                   |   |          |     |    |   | ay       |          |   |
|                   |   |          |     |    |   | jiraan). |          |   |
|                   |   |          |     |    |   | **Qaybta |          |   |
|                   |   |          |     |    |   | 5 u-bood |          |   |
|                   |   |          |     |    |   | hadii    |          |   |
|                   |   |          |     |    |   | aad      |          |   |
|                   |   |          |     |    |   | qortay   |          |   |
|                   |   |          |     |    |   | kees     |          |   |
|                   |   |          |     |    |   | nambarka |          |   |
|                   |   |          |     |    |   | Fuud     |          |   |
|                   |   |          |     |    |   | Stambaha |          |   |
|                   |   |          |     |    |   | ama      |          |   |
|                   |   |          |     |    |   | TANF**   |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| **Qaybta 2. Hadii |   |          |     |    |   |          |          |   |
| uu cunuga aad u   |   |          |     |    |   |          |          |   |
| buuxinayso uu     |   |          |     |    |   |          |          |   |
| yahay qof aan     |   |          |     |    |   |          |          |   |
| guri-laawe, qof   |   |          |     |    |   |          |          |   |
| wadankiisa ka soo |   |          |     |    |   |          |          |   |
| haajiray, ama     |   |          |     |    |   |          |          |   |
| baxsad ah         |   |          |     |    |   |          |          |   |
| sanduuqa ku       |   |          |     |    |   |          |          |   |
| haboon saar       |   |          |     |    |   |          |          |   |
| calaamada saxda   |   |          |     |    |   |          |          |   |
| ah iyo wac \[your |   |          |     |    |   |          |          |   |
| school, homeless  |   |          |     |    |   |          |          |   |
| liaison, migrant  |   |          |     |    |   |          |          |   |
| coordinator at    |   |          |     |    |   |          |          |   |
| phone #\]**       |   |          |     |    |   |          |          |   |
| Guri-laawe       |   |          |     |    |   |          |          |   |
| Muhaajir         |   |          |     |    |   |          |          |   |
| Baxsasho         |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| **Part 3. Cunug   |   |          |     |    |   |          |          |   |
| la koriyo**       |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| Hadii arjigan loo |   |          |     |    |   |          |          |   |
| buxinaayo cunug   |   |          |     |    |   |          |          |   |
| ay                |   |          |     |    |   |          |          |   |
| mas'uuliyadiisu   |   |          |     |    |   |          |          |   |
| hayso cayrta, ama |   |          |     |    |   |          |          |   |
| maxkamada,        |   |          |     |    |   |          |          |   |
| sanduuqan saar    |   |          |     |    |   |          |          |   |
| calaamada saxda  |   |          |     |    |   |          |          |   |
| kadibna ku qor    |   |          |     |    |   |          |          |   |
| daqliga bil kasta |   |          |     |    |   |          |          |   |
| kaaga baxa        |   |          |     |    |   |          |          |   |
| cunuga:           |   |          |     |    |   |          |          |   |
| \$\_\_            |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_. |   |          |     |    |   |          |          |   |
| U bood qaybta 5.  |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| **Qaybta 4.       |   |          |     |    |   |          |          |   |
| Daqliga Guud ee   |   |          |     |    |   |          |          |   |
| Soo Gala          |   |          |     |    |   |          |          |   |
| Guriga---Waa in   |   |          |     |    |   |          |          |   |
| aad noo sheegtaa  |   |          |     |    |   |          |          |   |
| inta ay tahay iyo |   |          |     |    |   |          |          |   |
| inta jeer**       |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| **1. Magaca**     | * |          |     |    |   |          |          | * |
|                   | * |          |     |    |   |          |          | * |
| (Qor **Qofkasta** | 2 |          |     |    |   |          |          | 3 |
| guriga ku degan)  | . |          |     |    |   |          |          | . |
|                   | D |          |     |    |   |          |          | C |
|                   | a |          |     |    |   |          |          | a |
|                   | q |          |     |    |   |          |          | l |
|                   | l |          |     |    |   |          |          | a |
|                   | i |          |     |    |   |          |          | m |
|                   | g |          |     |    |   |          |          | a |
|                   | a |          |     |    |   |          |          | d |
|                   | G |          |     |    |   |          |          | e |
|                   | u |          |     |    |   |          |          | e |
|                   | u |          |     |    |   |          |          | y |
|                   | d |          |     |    |   |          |          | h |
|                   | i |          |     |    |   |          |          | a |
|                   | y |          |     |    |   |          |          | d |
|                   | o |          |     |    |   |          |          | i |
|                   | i |          |     |    |   |          |          | i |
|                   | n |          |     |    |   |          |          | D |
|                   | t |          |     |    |   |          |          | a |
|                   | a |          |     |    |   |          |          | q |
|                   | j |          |     |    |   |          |          | l |
|                   | e |          |     |    |   |          |          | i |
|                   | e |          |     |    |   |          |          | J |
|                   | r |          |     |    |   |          |          | I |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
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+-------------------+---+----------+-----+----+---+----------+----------+---+
| *(Tusaale ahaan)\ | \ |          | \$[ |    | \ |          | \$\_\_\  | - |
| Jane Smith*       | $ |          | 150 |    | $ |          | _\_\_\_/ |   |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
|                   | _ |          | _\_ |    | _ |          | \_\_\_\_ |   |
|                   | \ |          | \_\ |    | \ |          |          |   |
|                   | _ |          | _/\ |    | _ |          |          |   |
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+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
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|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
|                   | _ |          | _\_ |    | _ |          | \_\_\_\_ |   |
|                   | \ |          | \_\ |    | \ |          |          |   |
|                   | _ |          | _/\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | / |          |     |    | / |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
|                   | _ |          | _\_ |    | _ |          | \_\_\_\_ |   |
|                   | \ |          | \_\ |    | \ |          |          |   |
|                   | _ |          | _/\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | / |          |     |    | / |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
|                   | \ |          | \   |    | \ |          | \$\_\    | - |
|                   | $ |          | $\_ |    | $ |          | _\_\_\_\ |   |
|                   | \ |          | \_\ |    | \ |          | _/\_\_\_ |   |
|                   | _ |          | _\_ |    | _ |          | \_\_\_\_ |   |
|                   | \ |          | \_\ |    | \ |          |          |   |
|                   | _ |          | _/\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          | \_\ |    | _ |          |          |   |
|                   | \ |          | _\_ |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | / |          |     |    | / |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
|                   | \ |          |     |    | \ |          |          |   |
|                   | _ |          |     |    | _ |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| **Qaybta 5.       |   |          |     |    |   |          |          |   |
| Saxiix iyo and    |   |          |     |    |   |          |          |   |
| Soshal            |   |          |     |    |   |          |          |   |
| Sekuyuuriti       |   |          |     |    |   |          |          |   |
| Nambar (Qof       |   |          |     |    |   |          |          |   |
| qaan-gaar waa in  |   |          |     |    |   |          |          |   |
| uu saxiixaa)**    |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+
| Xubin guriga      |   |          |     |    |   |          |          |   |
| degan oo          |   |          |     |    |   |          |          |   |
| qaan-gaar ah waa  |   |          |     |    |   |          |          |   |
| in uu saxiixaa    |   |          |     |    |   |          |          |   |
| arjiga. Hadii     |   |          |     |    |   |          |          |   |
| Qabta 4           |   |          |     |    |   |          |          |   |
| dhamaystiran      |   |          |     |    |   |          |          |   |
| tahay, qofka      |   |          |     |    |   |          |          |   |
| qaan-gaarka ah ee |   |          |     |    |   |          |          |   |
| saxiixaya foormka |   |          |     |    |   |          |          |   |
| waa in uu ama in  |   |          |     |    |   |          |          |   |
| ay ku qortaa      |   |          |     |    |   |          |          |   |
| Nambarka Soshal   |   |          |     |    |   |          |          |   |
| Sekiyuuritigooda  |   |          |     |    |   |          |          |   |
| ama ku calaamade  |   |          |     |    |   |          |          |   |
| sanduuqa ku qoran |   |          |     |    |   |          |          |   |
| "Ma haysto Soshal |   |          |     |    |   |          |          |   |
| Sekuuriti Nambar" |   |          |     |    |   |          |          |   |
| (arag Qoraalka    |   |          |     |    |   |          |          |   |
| Qodobka Sirta     |   |          |     |    |   |          |          |   |
| ShaqsiI ee ku     |   |          |     |    |   |          |          |   |
| qoran boggan      |   |          |     |    |   |          |          |   |
| gadaashii.)       |   |          |     |    |   |          |          |   |
|                   |   |          |     |    |   |          |          |   |
| *Waxaan marqaati  |   |          |     |    |   |          |          |   |
| ka ahay (balan    |   |          |     |    |   |          |          |   |
| qaadayaa) in      |   |          |     |    |   |          |          |   |
| dhamaan           |   |          |     |    |   |          |          |   |
| macluumaadka ku   |   |          |     |    |   |          |          |   |
| qoran arjigan     |   |          |     |    |   |          |          |   |
| yihiin kuwa run   |   |          |     |    |   |          |          |   |
| ah iyo laguna     |   |          |     |    |   |          |          |   |
| qoray dhamaan     |   |          |     |    |   |          |          |   |
| daqliga dhan.     |   |          |     |    |   |          |          |   |
| Waan ogahay in    |   |          |     |    |   |          |          |   |
| iskuulka lacagta  |   |          |     |    |   |          |          |   |
| uu ka heli doona  |   |          |     |    |   |          |          |   |
| Dowlada sare      |   |          |     |    |   |          |          |   |
| ayadoo la         |   |          |     |    |   |          |          |   |
| fiirinayo         |   |          |     |    |   |          |          |   |
| macluumaadka aan  |   |          |     |    |   |          |          |   |
| siiyay. Waan      |   |          |     |    |   |          |          |   |
| ogahay in         |   |          |     |    |   |          |          |   |
| maamulka iskuulka |   |          |     |    |   |          |          |   |
| laga yaabo in aay |   |          |     |    |   |          |          |   |
| soo baaraan       |   |          |     |    |   |          |          |   |
| (fiiriyaan)       |   |          |     |    |   |          |          |   |
| macluumaadka.     |   |          |     |    |   |          |          |   |
| Waan ogahay hadii |   |          |     |    |   |          |          |   |
| anigoo og aan     |   |          |     |    |   |          |          |   |
| siiyay facluumaad |   |          |     |    |   |          |          |   |
| been ah,          |   |          |     |    |   |          |          |   |
| caruurtayda loo   |   |          |     |    |   |          |          |   |
| diidi karo        |   |          |     |    |   |          |          |   |
| cuntada, iyo      |   |          |     |    |   |          |          |   |
| aniga laga yaabo  |   |          |     |    |   |          |          |   |
| in lay dacweeyo.* |   |          |     |    |   |          |          |   |
|                   |   |          |     |    |   |          |          |   |
| Halkan Saxiix:    |   |          |     |    |   |          |          |   |
| X\_\_\_\_\_\_\_\  |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_Magaca |   |          |     |    |   |          |          |   |
| ku                |   |          |     |    |   |          |          |   |
| daabac:\          |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_Taariikhda: |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\       |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
|                   |   |          |     |    |   |          |          |   |
| Cinwa             |   |          |     |    |   |          |          |   |
| anka:\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_Foon |   |          |     |    |   |          |          |   |
| Na                |   |          |     |    |   |          |          |   |
| mbarka:\_\_\_\_\_ |   |          |     |    |   |          |          |   |
| \_\_\_\_\_\_\_\_\ |   |          |     |    |   |          |          |   |
| _\_\_\_\_\_\_\_\_ |   |          |     |    |   |          |          |   |
|                   |   |          |     |    |   |          |          |   |
| Soshalo           |   |          |     |    |   |          |          |   |
| Sekiyuuriti       |   |          |     |    |   |          |          |   |
| Nambar: \_\_ \_\_ |   |          |     |    |   |          |          |   |
| \_\_ - \_\_       |   |          |     |    |   |          |          |   |
| \_\_ - \_\_ \_\_  |   |          |     |    |   |          |          |   |
| \_\_ \_\_  Ma    |   |          |     |    |   |          |          |   |
| haysto Soshal     |   |          |     |    |   |          |          |   |
| Sekiyuuriti       |   |          |     |    |   |          |          |   |
| Nambar            |   |          |     |    |   |          |          |   |
+-------------------+---+----------+-----+----+---+----------+----------+---+

February 2006 Free and Reduced Price School Meals Application

Somali Version Application

Page 2 of 4

+-----------------------------------------------------------------------+
| **Qaybta 6. Aqoonsiga Jinsiga Caruurta iyo midabka (qaybtaan          |
| iqtiyaar)**                                                           |
+-----------------------------------------------------------------------+
| [Calaamade hal ama ka badan aqoonsi jinsi:]{.underline}               |
|                                                                       |
| [Calaamadee aqoonsi jinsi]{.underline}                                |
+-----------------------------------------------------------------------+
| -   Aasiyan  Indiyan Amerikan ama Kuwa u dhashay Alaska  Isbaanish  |
|     ama kuwa ka soo jeeda Isbaanishka                                 |
|                                                                       |
| -   Cadaan  Udhashay Hawaaiyiyan ama Jasiirada Basifik kale         |
|     Isbaanish ama aanan ka soo jeedin Isbaanish                       |
|                                                                       |
|  Madow ama madowga Amerikanka  kuwa kale                            |
+-----------------------------------------------------------------------+
| **Qaybtan ha buuxin. Iskuulka in uu isticmaalo kaliya ayaa loogu tala |
| galay.**                                                              |
+-----------------------------------------------------------------------+
| Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice A    |
| Month x 24 Monthly x 12                                               |
|                                                                       |
| Total Income: \_\_\_\_\_\_\_\_\_\_\_\_ Per:  Week,  Every 2 Weeks,  |
|  Twice A Month,  Month,  Year Household size: \_\_\_\_\_\_\_\_     |
|                                                                       |
| Categorical Eligibility: \_\_\_ Date Withdrawn:                       |
| \_\_\_\_\_\_\_\_Eligibility: Free\_\_\_ Reduced\_\_\_ Denied\_\_\_    |
| Reason: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                |
|                                                                       |
| Temporary: Free\_\_\_\_\_ Reduced\_\_\_\_\_ Time Period:              |
| \_\_\_\_\_\_\_\_\_\_\_ (expires after \_\_\_\_\_ days)                |
|                                                                       |
| Determining Official's Signature:                                     |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\                                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_                                    |
|                                                                       |
| Confirming Official's Signature: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| Date: \_\_\_\_\_\_\_ Follow-up Official's Signature:                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date: \_\_\_\_\_\_               |
+-----------------------------------------------------------------------+

February 2006 Free and Reduced Price School Meals Application

Somali Version Application

Page 3 of 4

**Caruurtaada waxaa laga yaabaa in ay u qalmaan cuntada lacagteedu jaban
tahay ama bilaash ah hadii daqliga soo gala gurigaaga yahay mid xadkiisu
la siman ama ka yar jadwalka ay dowlada gooysay.**

**Qodobka Sharciga Qarsoodiga: Tani waxay sharxatsaa sida aan anaga u
isticmaali doono macluumaadka aad na siiso.**

Sharciga Cuntada Iskuulada Qaranka ee Richard B. Russell wuxuu u baahan
yahay macluumaadka ku qoran arjigan. Macluumaadka ma aha in aad bixiso,
balse hadii aadan bixin, uma ogolaan karno cunugaaga in uu helo cuntada
lacagteedu jaban tahay ama bilaashka ah. Waa in aad ku qortaa soshal
sekuuriti nambarka qofka qofka guriga degan ee qaan-gaarka ah oo
saxiixaya arjigaan. Soshal sekuyuuriti nambar lagaama baahana hadii aad
u buuxinayso cunug aad korsanayso ee aadan dhalin ama aad ku arjiga ku
qortay in aad qaadato Fuud Stambe, Barnaamijka Caawimaada Ku meel gaarka
ah ee la siiyo Qoosaska u baahan (TANF) ama kees nambarka Barnaamijka
Qaybista Raashinka ee Deegaamada Indianska (FDPIR) ama cadeemo FDPIR
kale ee la xiriira cunugaaga ama hadii aad ku qortay qofka qaan-gaarka
ah guriga degan in uu san lahayn namabarka soshal sekiyuuriti.
Macluumaadkaaga waxay u isticmaalaynaa hadii uu cunugaaga uu xaq u lee
yahay in uu helo cuntada lacagteedu jaban tahay ama bilaashka ah, iyo
maamulaynta iyo fullinta barnaamijka quraacda iyo qadada. Waxaa LAGA
YAABAA in aan macluumaadka la qaybsano waxbarashada, caafimaadka iyo
barnaamijyada nafaqada si ay u caawiso in ay qiimeeyaan, maal gelin, ama
lagu ogaado manaafacaadyada barnaamijyadooda, tafatiraasha barnaamika si
dib loogu habeeyo, iyo masuuliyiinta ilaalisa sharciga si ay u caawiso
in ay ogaadaan kuwa jebinaaya sharciyada.

**Qodobka Midab-kala-Saarka: Tani waxay sharxaysaa waxaad samayn lahayd
hadii aad amminsan tahay in si aan cadaalad ku jiran laguula
macaamilooday.** Sida uu qabo sharciga Dowlada iyo Sharciga Wakaalada
Beeraha ee Mareekanka, machadkan waa laga mamnuucay in uu takooro dadka
asagoo u fiirinaayo jinsiga, midabka, wadanka ay ka soo jeedaan, jinsi,
da', ama curyaannimo. Hadaad dacwad takoor aad samaynayso, warqad u qor
*USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW,
Washington DC 20250-9410* ama wac 800-795-3272 ama 202-720-6382
(TTY-gaba). USDA waxay bixisaa fursad shaqaalaysi oo loo wada siman
yahay.

February 2006 Free and Reduced Price School Meals Application

Somali Version Application

Page 4 of 4

**MACLUUMAAD WADAAGA MEDICAID/SCHIP**

Mudane Waalid/Ilaaliye:

Hadii caruurtaada la siiyo cuntada lacagta jaban ama bilaashka ah, waxay
ka loo awoodaan in ay helaan caymis caafimaad lacagteedu jaban tahay ama
bilaash ah taasoo ay ka heli karaan Medicaid ama Barnaamijka Caymiska
Caafimaadka Caruurta ee Gobolka (SCHIP). Caruurta haysata caymiska
caafimaadka waxay u badan tahay badanaaba in ay helaan daryeel caafimaad
iyo caafimaadkiisa darted waxayn u badan tahay in uu iskuulka wax-yar
kaliya ka haro.

Sababtoo ah caymiska cafimaadka muhiim wayn ay tuhay wanaaga caruurta,
**sharciga wuxuu noo ogalaadaa in aan Medicaid iyo SCHIP u sheegno in
caruurtaada ay xaq u lee yihiin cuntada lacagta jaban ama bilaashka ah,
*hadii aadan na oran ha sheegin maahane. ***Medicaid iyo SCHIP
macluumaadka waxay kaliya isticmaalaan in ay ku ogaadaan caruurta laga
yaabo in ay xaqu u lee dahay barnaamijkooda. Masuuliyiinta barnaamijka
waxaa laga yaabaa in ay kula soo xiriiraan si ay caruurtaada ugu soo
bandhigaan (Buuxinta Arjiga Cuntada Lacagta Jaban ama Bilaashka ah taasi
isla markiiba micnaheedu ma aha in caruurtaada caymiska caafimaadka lagu
diiwaan geliyay).

Hadii aadan rabin in anagu aan macluumaadkaaga la qaybsanin Medicaid ama
SCHIP, foomka hoose soo dhamaystir kuna soo dir (Soo diritaanka foomkan
waxba kama bedelaayo hadii ay caruurtaada heli lahayd cuntada lacagta
jaban ama tan bilaashka ahba).

-   **Maya! Ma** rabo in macluumdkayga ku qoran Arjiga Cuntada Lacagta
    Jaban ama Bilaashka ah lala wadaago Medicaid ama Barnaamijka
    Caymiska Caafimaad Caruurta ee Gobolka.

**Hadii aad calaamada saxda ah aad Maya saartay, foomkan hoose buuxi.**

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Saxiixa Waalidka/Illaaliye: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Taariikh:
\_\_\_\_\_\_\_

Magaca ku daabac: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cinwaan:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Macluumaad dheeraad ah, waxaad soo waci kartaa **\[name\]** ka wac
**\[phone\]**.

**Foomkan ku soo celi: \[address\] soona celi \[date\].**

**MACLUUMAAD WADAAGA BARNAAMIJYADAHA KALE**

Mudane Waalid/Ilaaliye:

Si woqtigaaga iyo dadaalkaaga loo dhowro, macluumaadkaaga ee aad noogu
soo gudbisay Arjiga Cuntada Lacagta Jaban iyo Tan Bilaashka ah waxaa
lala wadaagi doonaa barnaamijyo kale oo laga yaabo in caruurtaada ay
xaq-u leeyihiin. **Barnaamijyada soo socda, waa in ay haysanaa
ogolaanshahaaga si aan macluumaadkaaga la wadaagno. Soo diritaanka
foomkan wax kama bedeli doono in caruurtaada ay heli doonaan cuntada
lacagta jaban iyo cuntada bilaashka ah iyo hadii kale.**

-   **Maya! Ma** rabo in macluumdkayga ku qoran Arjiga Cuntada Lacagta
    Jaban ama Bilaashka ah lala wadaago Medicaid ama Barnaamijka
    Caymiska Caafimaad Caruurta ee Gobolka.

```{=html}
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```
-   Haa! **Aniga Waan** doonayaa in mas'uuliyiinta iskuulka in
    macluumaadka ku qoran Arjiga Cuntada Lacagta Jaban iyo Tan Bilaashka
    ah la wadaagaan **\[name of program specific to your school\]**.

-   Haa! **Aniga Waan** doonayaa in mas'uuliyiinta iskuulka in
    macluumaadka ku qoran Arjiga Cuntada Lacagta Jaban iyo Tan Bilaashka
    ah la wadaagaan **\[name of program specific to your school\]**.

-   Haa! **Aniga Waan** doonayaa in mas'uuliyiinta iskuulka in
    macluumaadka ku qoran Arjiga Cuntada Lacagta Jaban iyo Tan Bilaashka
    ah la wadaagaan **\[name of program specific to your school\]**.

**Hadii aad haa kaga jawaabay mid ka mid ah ama dhamaan sanduuqyada
kore, buuxi foomka hoose. Macluumaad yadaada waxaa lala wadaagayaa oo
kaliya barnaamijyada aad dalbatay.**

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Magaca Cunuga:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Iskuulka:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Saxiixa Waalidka/Illaaliye: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Taariikh:
\_\_\_\_\_\_\_

Magaca ku daabac: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Cinwaanka:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Macluumaad dheeraad ah, waxaad soo waci kartaa **\[name\]** ka wac
**\[phone\]**.

**Foomkan ku soo celi: \[address\] soona celi \[date\].**

**ARJIGAAGA WAA IN AAN BAARIS KU SAMAYNAA**

**Waa in aad soo dirtaa macluumaadka aan anaga u baahan nahay, ama la
xiriir \[name\] taariikh tan \[date\], ama caruurtaada waalaga joojin
doonaa in la siiyo cuntada lacagta jaban ama bilaashka ah.**

Iskuulka:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Taariikhda: \_\_\_\_\_\_\_\_\_\_\_

Gacaliye \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_:

Waxaan hubis ku samaynaynaa Arjiga Cuntada Lacagta Jaban iyo Bilaashka.
Sharciga dowlada wuxuu nagaga baahan in aan hubino si loo hubiyo kaliya
caruurta xaqqa u leh in la siiyo cuntada lacagta jaban ama bilaashka ah.
Waxaa kugu waajib ah in aad noo soo dirto macluumaad aad taa ku
cadaynayso in **\[names of children\]** ay xaq u leeyihiin. Hadii ay
suurto gal tahay, koobi noo soo dir, ha'soo dirin warqadaha asalka ah,
waxaa kaliya dib laguugu soo dirayaa hadii aad soo codsato.

**1. Hadii aad qaadanaysay Fuud Stambe ama TANF goorta aad codsanaysay
cuntada lacagta jaban ama bilaashka ah, ama woqti kale oo kaste ee
goortaasi ka dib, noo soo dir koobi ka mid ah ku wan:**

-   Shahaadada Wargelinta Fuud Stambe-aha ama TANF taasoo ku muujisan
    taariikhda shahaadada.

-   Warqad ka timid Xafiiska Cayrta ama Fuud Stambaha taasoo oranaysa in
    aad qaadanaysay Fuud Stambe ama TANF.

-   **Kaarkaaga EBT ha soo dirin.**

**2. Hadii warqadaan laguugu soo diray guri-laawe, muhaajir ama cunug
guri ka soo baxsaday, fadlan la xiriir. \[school, homeless liaison, or
migrant coordinator\] wixii caawimaad.**

**3. Hadii cunuga yahay cunug aad korsanayso:**

Soo dir dokumenti rasmi ah oo ka socda hayada mas'uulka ka ah cunuga.

**4. Hadii aadan caruurtaada u qaadanayn Fuud Stambe ama TANF:**

A.  Qor magaca iyo Nambarka Soshalka ee xubin kasta oo qaan gaar ah ee
    degan guriga.

+---------------------------+--------------------------------+--------+
| Magaca                    | > Nambarka Soshalka\           | Ma     |
|                           | > (Eeg Qodobka Sharciga ee     | haysto |
|                           | > Qarsoodiga, bogga 2)         | Na     |
|                           |                                | mabrka |
|                           |                                | So     |
|                           |                                | shalka |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+
| \_\_\_\_\_\_\_\_\_\_\_\   | \_\_ \_\_ \_\_ - \_\_ \_\_ -   | -      |
| _\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ \_\_ \_\_ \_\_            |        |
+---------------------------+--------------------------------+--------+

B.  Soo dir boggan ayadoo la socota warqadaha ay ku qoran yihiin caddada
    lacag ee guryaha dadka degan soo gasho iyo halka ay ka soo gasho.

Warqadaha aad soo direyso waa in ay ku qoran yihiin **Magaca** qofka
daqliga soo gala, **taariikhda** daqliga uu soo galay, **caddada
lacagta** inta ay tahay, iyo **inta jeer** lacagta soo gashay.
**Macluumaadka ku soo dir: \[address\].**.

**[Warqadaha la ogolaan doono waxaa ka mid ah:]{.underline}**

**Shaqooyinka:** Jeega dabadisa ama bakhshada lacagta taasoo lagu
muujiyay caddada iyo inta jeer ee aad lacagta shaqada qaadato; warqad ka
timid shirkada aad u shaqayso warqadaasoo lagu muujiyay mishaharkaaga
guud inta uu yahay iyo inta jeer ay mishahark ku siyaan; ama mehrada ama
warqadaha beeraha, sida buuga canshuurta ama buuga diiwan gelinta
daqliga.

**Warqadaha Soshal Sekiyuuriti, Hoolgabka, ama Shaqo Ka fariisiga:**
Warqada manfaca Soshal Sekiyuuritiga, warqad cadayn inta lacag ee aad ka
heshay, ama digniinta warqada howlgabka inta lagu siin doono.

**Lacagta lagu siiyo marka aad Shaqo-la'aan tahay, curyaan tahay, ama
Magdhowga Shaqaalaha:** Ogeysiinta xaq u lahaanshaha ee ka yimid
xafiiska shaqaalaha, jeega dabadiisa, ama warqad ka timid Xafiiska
Magdhowga Shaqaalaha.

**Lacagaha Cayrta:** Warqada manfaca ee ka timid wakaalada cayrta.

**Masaruufka cunuga ama Masruuf:** Amarka maxkamada, heshiis, ama
koobiga jeegaga aad heshay.

**Daqli kale (sida daqliga kirada):** Macluumaad ku qoran caddada daqli
ee aad hesho, ilaa iyo inta jeer ee aad hesho, iyo taariikhda aad
heshay.

**Daqli kuma soo galo:** Warqad yar soo qor adigoo sharaxaya sida aad
reerkaaga ugu hesho cuntada, dharka iyo guryahaba, iyo goorta aad
rajaynayso in daqli ku soo galo.

**Qorshaynta Guryaha Askarta:** Warqad heshiiska kirada ayadoo ku qoran
in guryaha aad degan tahay uu ka mid yahay Qorshaynta Guryaha Askarta.

**Dokumenti Daqli la ogolaankaro ee Waqti go'an leh:** Fadlan soo dir
warqado ay ku qoran tahay daqligaaga inta uu ahaan jiray goorta aad
codsatay. Hadii macluumaadkan aadan haynin, warqadaha waxaad noo soo
diri kartaa laga bilaabo woqtiga aad codsiga samaysay ilaa iyo woqtiga
laga soo cadaynaayo.

Hadii aad wax su'aalo hayso ama aad u baahan tahay cawimaad, fadlan wac
**\[name\]** ka wac **\[phone number\]**. Wacitaanka waa bilaash.
**\[Toll free or reverse charge explanation\].**

Daacadnimo,

**\[signature\]**

Qoraalka Qodobka Sirta Shaqsi: Sharciga Cuntada Iskuulada Qaranka ee
Richard B. Russell wuxuu u baahan yahay macluumaadka ku qoran arjigan.
Macluumaadka ma aha in aad bixiso, balse hadii aadan bixin, uma ogolaan
karno cunugaaga in uu helo cuntada lacagteedu jaban tahay ama bilaashka
ah. Waa in aad ku qortaa soshal sekuuriti nambarka qofka qofka guriga
degan ee qaan-gaarka ah oo saxiixaya arjigaan. Soshal sekuyuuriti nambar
lagaama baahana hadii aad u buuxinayso cunug aad korsanayso ee aadan
dhalin ama aad ku arjiga ku qortay in aad qaadato Fuud Stambe,
Barnaamijka Caawimaada Ku meel gaarka ah ee la siiyo Qoosaska u baahan
(TANF) ama kees nambarka Barnaamijka Qaybista Raashinka ee Deegaamada
Indianska (FDPIR) ama cadeemo FDPIR kale ee la xiriira cunugaaga ama
hadii aad ku qortay qofka qaan-gaarka ah guriga degan in uu san lahayn
namabarka soshal sekiyuuriti. Macluumaadkaaga waxay u isticmaalaynaa
hadii uu cunugaaga uu xaq u lee yahay in uu helo cuntada lacagteedu
jaban tahay ama bilaashka ah, iyo maamulaynta iyo fullinta barnaamijka
quraacda iyo qadada.

Qodobka Midab-kala-Saarka: Tani waxay sharxaysaa waxaad samayn lahayd
hadii aad amminsan tahay in si aan cadaalad ku jiran laguula
macaamilooday. Sida uu qabo sharciga Dowlada iyo Sharciga Wakaalada
Beeraha ee Mareekanka, machadkan waa laga mamnuucay in uu takooro dadka
asagoo u fiirinaayo jinsiga, midabka, wadanka ay ka soo jeedaan, jinsi,
da', ama curyaannimo. Hadaad dacwad takoor aad samaynayso, warqad u qor
*USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW,
Washington DC 20250-9410* ama wac 800-795-3272 or 202-720-6382
(TTY-gaba)

. USDA waxay bixisaa fursad shaqaalaysi oo loo wada siman yahay.

**ARJIGAAGA WAAN BAARNEY**

Iskuul:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Taariikh: \_\_\_\_\_\_\_\_\_\_\_

Mudane
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_:

Waan hubbinay macluumaadka aad noo soo dirtay in **\[names of children**
xaq-u lee yahay cuntada lacagteedu jaban tahay ama tan bilaashka ah iyo
waxaan go'aaminay in:

-   Cunugaaga xaq u lahaanshihiisa barnaajika is bedelin.

-   Laga bilaabo **\[date\]**, Cunugaaga xaqa uu uleeyahay cuntada waxaa
    laga bedeli doonaa **cuntada lacagta jaban waxaana loo bedelayaa in
    uu ku cuno** bilaash sababtoo ah daqligaaga wuxuu hoos immanayaa
    xadka loogu tala galay ee uu cuntada xaqa uu ugu yeeshay.
    Caruurtaada waxay heli doonaan cunto lacag la'aan ah.

-   Laga bilaabo **\[date\]**, cunugaaga xaqa uu uleeyahay cuntada
    **bilaashka** waa laga bedelayaa oo waxaa loogu bedelayaa **cuntada
    lacagta jaban** maxaa yeelay daqligaaga wuxuu kur u dhaafay xadkii.
    Qiimaha cuntada lacagteedu jaban tahay qadada waa **\[\$\]**
    quraacdana waa **\[\$\]**

-   Laga bilaabo **\[date\]**, **cunugaaga xaq uma laha** cuntada
    lacagteedu yartahay ama bilaashka ah sababtana waa sida tan soo
    socota:

> \_\_\_ Rekorkeena waxuu natussayaa aadan horey u qaadanin Fuud Stambe,
> ama TANF.
>
> \_\_\_ Rekoorkeena waxaa natussayaa in cunugaaga/caruurtaada aysan
> ahayn kuwa aan guri lahayn, guri ka soo orday, ama muhaajir.
>
> \_\_\_ Daqligaaga ku soo gala wuxuu kor u dhaafay xadka loogu tala
> galay cuntada lacagteedu jaban tahay ama bilaashka ah.
>
> \_\_\_ Adiga nama siin ama nama
> tussin:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_ Codsigeena kama soo jawaabin.
>
> Qiimaha Qadada waa **\[\$\]** quraacdana waa **\[\$\]**. Hadii daqliga
> gurigaaga soo gala hoos u dhaco ama xubnaha qooska kor u kaco, dib
> ayaad u codsan kartaa. Hadii aadan wax cadeeya in aad xaq u lee dahay
> na tussin, waxaa lagu weydiin doonaa marka goorta aad dib u codsato.

Hadii aadan go'aan kan ku qanacsanayn, waxaad kala hadli kartaa
**\[name\]** ka wac **\[phone\]**. Waxaad kaloo xaq u lee dahay dhegaysi
dacwad xaq ah. Hadii aad dhegaysi dacwad dalbato maalintaan, caruurtaada
way u sii socon doontaa in la siiyo cuntada lacagta jaban ama cuntada
bilaashka ah ilaa iyo mas'uuliyiinta dhegaysiga dawcada go'aan ka
gaaraan. Waxaad dhegaysiga dacwada ka codsansan kartaa adigoo waca ama u
qora: **\[name\]**, **\[address\]**, **\[phone number\]**.

Daacadnimo,

**\[signature\]**

Qodobka Midab-kala-Saarka: Tani waxay sharxaysaa waxaad samayn lahayd
hadii aad amminsan tahay in si aan cadaalad ku jiran laguula
macaamilooday. Sida uu qabo sharciga Dowlada iyo Sharciga Wakaalada
Beeraha ee Mareekanka, machadkan waa laga mamnuucay in uu takooro dadka
asagoo u fiirinaayo jinsiga, midabka, wadanka ay ka soo jeedaan, jinsi,
da', ama curyaannimo. Hadaad dacwad takoor aad samaynayso, warqad u qor
*USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW,
Washington DC 20250-9410* ama wac 800-795-3272 or 202-720-6382
(TTY-gaba). USDA waxay bixisaa fursad shaqaalaysi oo loo wada siman
yahay.