Fort Worth Independent School District

Letter to Households (Multi-Child)

National School Lunch/School Breakfast Programs

School Year 2009-2010

Dear Parent/Guardian:

Children need healthy meals to learn. The Fort Worth Independent School District offers healthy meals every school day. Breakfast costs $0.75 ; lunch costs $1.50 in elementary schools and $1.75 in secondary schools; and after school snacks are free . Your children may qualify for free meals or for reduced-price meals. Reduced breakfast is free and the reduced price is $0.40 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. You may return the completed application to:

Fort Worth ISD, Child Nutrition Services, 601 E. Northside Drive, Fort Worth, Texas 76164 (817) 740-5500

Or complete the application on-line at www.fortworthisd.org

2. Who can get free meals? Children in households getting Supplemental Nutrition Assistance Program (SNAP) benefits (formerly the Food Stamp Program) or TANF can get free meals regardless of your income. Your benefit letter from the Texas Health and Human Services Commission (HHSC) is your documentation for free meals. If you have not already received a letter from your school stating that your household is eligible for free meals, you may take your HHSC benefit letter to your child nutrition office to be certified for free meals. Call the school at (817) 740-3800 if you have questions.

3. 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? In most cases no, however read the letter you got carefully and follow the instructions. Call the school at (817) 740-3800 if you have questions. If your household does not receive SNAP or TANF, your children may still be eligible to receive free meals if your household income is less than the amount listed on the federal income Guidelines. Please complete the application and submit it to your child nutrition office. Head Start students and most foster children may also qualify for free meals.

4. Can homeless, runaway and migrant children get free meals? Yes. If you have not been notified of free status under these categories, please call the school district’s homeless liaison to see if your child(ren) qualify.

5. 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, included in this application packet.

6. I get WIC. 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 SNAP, TANF or other benefits.

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:

Lena Wilson, Director of Child Nutrition Services, 601 E. North Side Drive, Fort Worth, Texas 76164 (817) 740-5500

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 yourself and all people living in your household, related or not (such as children, grandparents, other relatives or friends).

12. What if my income is not always the same? List the amount that you normally receive. 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 pay, include that amount as income. If you do not normally get overtime pay, do not include it as income.

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.

FEDERAL INCOME CHART

For School Year 2009-2010

Household Size

Yearly

Monthly

Weekly

1

20,036

1,670

386

2

26,955

2,247

519

3

33,874

2,823

652

4

40,793

3,400

785

5

47,712

3,976

918

6

54,631

4,553

1,051

7

61,550

5,130

1,184

8

68,469

5,706

1,317

Each additional person

6,919

577

134

If you have other questions or need help, call ( 817) 740-3800. Si necesita ayuda, por favor llame al teléfono: (817) 740-3800. Si vous voudriez d’aide, contactez nous au numero: (817) 740-3800.

Sincerely,

Cecelia Speer

Cecelia Speer - Cheif of District Operations

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

Instructions for Applying 2009-10

Please complete application in blue or black ink.

Use a separate application for each foster child. List other children together.

If you are applying for a FOSTER CHILD, follow these instructions:

Part 1 : List the child’s name, birth date, grade, school ID and student ID number or social security number.

Part 2 : List the child’s personal use monthly income, if any.

Part 3 : Skip this part.

Part 4 : Sign the form. A Social Security Number is not necessary.

If your household receives Supplemental Nutrition Assistance Program (SNAP) Or Temporary Assistance For Needy Families (TANF), follow these instructions:

Part 1: List the child’s name, birth date, grade, school ID, student ID number or social security number and EDG# (Eligibility Group Number) for SNAP (formerly Food Stamp Program) or TANF.

Part 2 : Skip this part.

Part 3: Skip this part.

Part 4: Sign the form. A Social Security Number is not necessary.

ALL OTHER HOUSEHOLDS, follow these instructions:

Part 1: List the child’s name, birth date, grade, school ID and student ID number or social security number (to be used for school purposes only).

Part 2: Skip this part.

Part 3: Follow these instructions to report total household income from last month.

Column 1 — Name: List the last, first, and middle initial of each person living in your household, related or not (such as grandparents, other relatives or friends.) You must include yourself and all children. Attach another sheet of paper if needed.

Column 2 — Income and how often it is received: For each person who receives income, write the amount received and how often it is received — weekly, every 2 weeks, twice a month or monthly.

Employment Income: List the gross amount for each person. It is not the same as take-home pay. Gross income is the amount earned before taxes and deductions. It should be listed on your pay stub or your boss can tell you. Next to the amount, write how often you receive it — weekly, every 2 weeks, twice a month or monthly.

Other Income: List the amount each person receives from all other sources. Include welfare, child support, alimony,

pensions, retirement, Social Security, Worker’s Compensation, unemployment, strike benefits, Supplemental Security

Income (SSI), Veteran’s benefits (VA 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 receives it.

REQUIRED — if no income: If the person does not have any income, check the box.

Part 4: 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.

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 children for free or reduced-priced 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 Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) 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 children are 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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW Washington, D.C. 20250-9410 or call (800) 795-3272 or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.