Source: https://eat-ux.herokuapp.com/
Timestamp: 2018-10-21 21:09:49
Document Index: 612588280

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 1', 'art 4', 'art 5']

Springfield Academy - Application for Free and Reduced Price School Meals
Welcome to the free and reduced price school meals application for Springfield Academy.
This application has 4 sections to fill out, but the system may automatically skip sections based on the answers you give. It takes approximately 10 minutes to complete and you will have the chance to review before submitting. Submitting this application carries no risk to you, regardless of the final outcome.
If you have questions, please contact John Doe at 123-456-7890 or john.doe@springfield.edu.
To get started, please sign your first & last name below.
Signature of adult completing this form * This field is required
The person signing is furnishing true information and to advise that person that the application is being made in connection with the receipt of Federal funds; School officials may verify the information on the application; and Deliberate misrepresentation of the information may subject the applicant to prosecution under State and Federal statutes.
Part 1: Children Information
Anyone who is living with you and shares income and expenses, even if not related.
who are infants, children
Anyone age 18 or under and are supported with the household’s income; or in your care under a foster arrangement, or qualify as homeless, migrant, or runaway youth; or students attending high school grade 12 or under, regardless of age.
, and students up to and including grade 12
Migrant status is used only to determine eligibility for free or reduced price meals. We do not use this information for other purposes.
Other Status (check all that apply)
A child who is formally placed by a court or a State child welfare agency.
A child that is enrolled in a Federal Head Start or State-funded pre-kindergarten program that uses eligibility criteria that is identical or more stringent than Federal Head Start
, Homeless / Migrant / Runaway
Homeless: A child identified by the Local Education Agency (LEA) homeless liaison or by an official of a homeless shelter as lacking a fixed, regular, and adequate nighttime residence.
Migrant: A child identified as a migrant by the State or local Migrant Education Program coordinator or the local educational liaison, or other individual identified by FNS (Food and Nutrition Service).
Runaway: A child identified as a runaway receiving assistance under a program under the Runaway and Homeless Youth Act, by the local educational liaison, or other individual in accordance with guidance issued by FNS.
Child First Name First name is required Child Middle Initial Child Last Name Last name is required
Homeless / Migrant / Runaway
Foster: A child who is formally placed by a court or a State child welfare agency.
Head Start: A child that is enrolled in a Federal Head Start or State-funded pre-kindergarten program that uses eligibility criteria that is identical or more stringent than Federal Head Start.
CHILDREN’S RACIAL & ETHNIC IDENTITIES
Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.
We are required to ask for information about your children’s race and ethnicity to make sure we are fully serving our community.
Part 2: Assistance Programs
Indicate below if anyone in your household currently participates in SNAP, TANF, or FDPIR
SNAP: Supplemental Nutrition Assistance Program (formerly known as food stamps)
Based on the information you provided, you are not required to complete this section.
If your household participates in more than one assistance programs, please include only one of the case numbers below. It does not matter which one you choose to include.
If you’d like to learn more about these programs, take a look at the Food and Nutrition Services website.
Yes, at least one member of my household participates in SNAP, TANF, or FDPIR
Case Number * Since you indicated that you receive assistance, we need your case number
No, my household does not participate in assistance programs
Part 3: Household Income
Report income for all household members (adults and children)
Money received from outside your household that is paid directly to your children. Many households do not have any child income.
In part 1, you listed 1 child in your household.
For each child listed, if they receive income, report gross total income for each source in whole dollars only (before taxes and deductions). If there is no income to report, leave the amount at 0.
Bi-Weekly = every two weeks (26 paychecks a year).
2x A Month = twice a month (24 paychecks a year).
Earnings from Work +
Salary or wages from a job.
Social Security benefits for the child’s own blindness or disability, or because a parent is disabled, retired, or deceased.
Income from Other Household +
Spending money or other income from a person outside the household such as an extended family member or friend.
Income from any other source such as from a private pension fund, annuity, or trust.
Earnings from Work: Salary or wages from a job.
Social Security Benefits: Social Security benefits for the child’s own blindness or disability, or because a parent is disabled, retired, or deceased.
Income from Other Household: Spending money or other income from a person outside the household such as an extended family member or friend.
Other Income: Income from any other source such as from a private pension fund, annuity, or trust.
List all household members not listed above (including yourself) even if they do not receive income.
Household members do not necessarily have to be your immediate family. For example, grandparents, cousins, or friends who live with you and share income and living expenses count as household members.
For each adult household member listed, if they receive income, report gross total income for each source in whole dollars only (before taxes and deductions). If there is no income to report, leave the amount at 0.
Adult’s First Name *
Public Assistance/Child Support/Alimony +
Adult First Name First name is required Adult Last Name Last name is required
$ Earnings amount is required (enter 0 if none)
Earnings from Work Frequency
Adult Earnings from Work Frequency
Please select a frequency for earnings
Public Assistance/Child Support/Alimony
$ Assistance amount is required (enter 0 if none)
Public Assistance/Child Support/Alimony Frequency
Adult Public Assistance Frequency
Please select a frequency for assistance
$ Pension amount is required (enter 0 if none)
Adult Pension Frequency
Please select a frequency for pension
My household has 0 members and earns $ 0 annually.
United States citizenship or immigration status is not a condition of eligibility for free and reduced price lunch benefits. Your children may still be eligible for this benefit even if you do not have a Social Security Number (SSN).
If more than one person in your household has a SSN, please include only one number below. It does not matter which one you choose to include.
Does the primary wage earner or another member in your household have a Social Security Number (SSN)?
Yes, a member in my household has a SSN
Last 4 digits of SSN * Since you indicated that you have a SSN, we need the last 4 digits of your SSNPlease make sure you enter a 4-digit number
No, no one in my household has a SSN
SSN information is required
Part 4: Adult Contact Information
State * (State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State is required
Phone Number Phone number seems invalid; make sure it’s formatted properly (e.g. 312-456-7890)
Email Email seems to be invalid; make sure it’s formatted properly (e.g. name@mail.com)
Part 5: Summary & Submit
Review your application before you submit it
ADULT SIGNER Edit
CHILDREN INFORMATION Edit
ASSISTANCE PROGRAMS Edit
(Information not required)
My household has 2 members and earns $ 0 annually.
No SSN information entered.
ADULT CONTACT INFORMATION Edit
Your application has been submitted and you don’t need to do anything further.
We will review your information and you will receive a letter in the mail if you are eligible for this benefit.
In the meantime, please contact John Doe at 123-456-7890 or john.doe@springfield.edu if you have questions.
GO TO SPRINGFIELD ACADEMY
Please review errors in this section