School Meal Benefits Application

Children in the household

List every child you are applying for who is a student. You can add more than one.

Assistance programs

Does anyone in your household currently receive benefits from any of these programs?

Yes — SNAP, TANF (cash assistance), or FDPIR

Case number (for any one program above) If you provide a valid case number, you usually don't need to report income.

Household members & income

List everyone living in your household, and the gross income each receives.

Signature & contact

An adult household member must sign. Typing your name acts as your electronic signature certifying the information is true.

Signature (type full name)

Date

Last 4 digits of signer's Social Security Number Required unless you check the box below. The signer does not have a Social Security Number

Phone optional

Email optional

Mailing address optional Child's racial / ethnic identity optional — does not affect eligibility

Review & submit

Please check everything below, then submit.

Application submitted

Stored submissions for this district. Preliminary status is an estimate only — the district makes the official determination.

Prototype. Household and student data is sensitive — treat it under FERPA and your data-security policy.