Gwinnett County Public Schools
School Meals Family Application
2007-2008
Important! Call 1-866-875-3346 for results. You will need your child’s Gwinnett County ID number.
Notification letters will be sent if you are approved temporary, if you are denied benefits or if there is a change
in your current status.
Complete one form for each family.
Sending separate applications for your children may delay your approval. We process all applications at a
central site, not at local schools.
Return the application to any local school cafeteria.
Allow 10 days for processing.
It may take up to 10 days for your application to be processed. Students will be expected to pay full price for
meals until the application has been processed and parents are responsible for charges made before processing
and approval.
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, 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 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 Avenue, SW, Washington DC 20250-9410 or call 202-720-5964 (voice and TDD). USDA is an
equal opportunity provider and employer.
Dear Parent/Guardian,
Children need healthy meals to learn. Gwinnett County Public Schools offer healthy meals every school day.
Breakfasts cost $1.00, lunches cost $1.75 at elementary and $2.00 at middle and high schools. Reduced price
meals cost $.30 for breakfast and $.40 for lunch.
1. Do I need to fill out an application for each child? No. Use one Free and Reduced Price School Meals
Application for all children in your household. We cannot approve an application that is not complete, so be
sure to fill out all required information. Return the completed form to any local school cafeteria manager.
2. Who can get free meals? Children in households getting Food Stamps or TANF 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? Yes, if you have not been informed that
they will get free meals please call 678 301-6307 to see if your child(ren) qualify.
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 carefully and follow the instructions. Call 678 301-6307 if you have questions.
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 receiving Food Stamps, TANF 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: Alice Ertley, School Nutrition Program, 437 Old
Peachtree Road, Suwanee, GA 30024-2978, telephone 678 301-6307.
10. May I apply if someone in my household is not a United States citizen? Yes. You or your child(ren) do
not have to be a United States 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 678 301-6307.
Si necesita ayuda, por favor llame al teléfono 678 301-6307.
Si vous voudriez d’aide, contactez nous au numero 678 301-6307.
Sincerely,
Ken Yant,
School Nutrition Program Director
Federal Income Eligibility Guidelines for School Year 2007-2008
Households at or below the reduced price limits are eligible for either free or reduced price meals.
HOUSEHOLD SIZE
1
2
3
4
5
6
7
8
FOR EACH ADDITIONAL
FAMILY MEMBER ADD
YEARLY
18,889
25,327
31,765
38,203
44,641
51,079
57,517
63,955
6,438
MONTHLY
1,575
2,111
2,648
3,184
3,721
4,257
4,794
5,330
537
WEEKLY
364
488
611
735
859
983
1,107
1,230
124
Instructions for Scanning Form (no red, pink or purple ink)
Part 1:
If the child is homeless, migrant or a runaway, check the appropriate box and call 678- 301-6307.
Part 2:
If your child is a Foster Child, check the box and print the child’s personal gross monthly income.
You do not need to include your Social Security Number for a foster child. A signature is required.
Part 3:
Complete one line for each child attending Gwinnett County Schools – include all your children in
elementary, middle and high school.
Print the Gwinnett County student ID number if you know it.
Print each child’s name as listed on Gwinnett County School Records (required).
Print each child’s date of birth and grade.
If you receive food stamps or TANF, print the case number for each child. Do not list your debit card
number.
If your child has income, print the gross monthly income.
•
•
•
•
•
Part 4:
List all adults and children not attending Gwinnett County Schools (Do not list if entered in Part 3).
• Print first and last name of all other people living in the household.
• Check the box if the household member does not have income.
• If the household member has income, print the gross monthly income (amount earned before taxes
and deductions) in the appropriate column.
Part 5:
Print the total number of people living in the household. Add names listed in Parts 3 and 4.
Part 6:
Certification, Signature (required) and Social Security Number.
Print your social security number or X if you do not have one.
A social security number is not required for foster children, food stamp and TANF recipients.
A signature is required. Your application will be returned without one.
Print your first and last name and the date you sign the form.
•
•
•
•
Part 7:
Sign for permission to share information.
Part 8:
Print your mailing information and a daytime telephone number.
Part 9:
Optional
Instrucciones para llenar la solicitud (por favor no use bolígrafo con tinta roja, rosada o púrpura)
Sección 1: Si el niño no tiene hogar, ha abandonado su hogar o es un niño emigrante, marque la casilla apropiada y
llame al 678- 301-6307.
Sección 2: Si el niño es hijo de crianza o está en un hogar temporal, marque la casilla apropiada y escriba los
ingresos brutos personales y mensuales del niño. No necesita incluir su número de Seguro Social si su
niño se encuentra en un hogar temporal. Se requiere la firma.
Sección 3: Llene una línea por cada niño que estudie en las Escuelas del Condado de Gwinnett – incluya a todos sus
niños que asistan a la escuela primaria, secundaria, o preparatoria.
•
Escriba el número de identificación del estudiante que asiste a las Escuelas Públicas del Condado de
Gwinnett, si lo sabe.
•
Escriba el nombre de cada niño como aparece en los expedientes académicos de las Escuelas Públicas
del Condado de Gwinnett – se requiere que nos provea esta información.
•
Escriba la fecha de nacimiento de cada niño y su grado escolar.
•
Si usted recibe Cupones de Alimentos o TANF, escriba el número del caso asignado para cada niño. No
escriba el número de la tarjeta “Debit.”
• Si su niño recibe ingresos, escriba los ingresos brutos y mensuales que recibe.
Sección 4: Escriba los nombres de todos los adultos y niños que viven con usted y que NO estudien en las Escuelas
del Condado de Gwinnett (No los incluya en esta sección si ya los escribió en la Sección 3)
•
Escriba el primer nombre y el apellido de todas las otras personas que viven en su hogar.
•
Marque la sección apropiada si el miembro de familia no tiene ingreso alguno.
•
Si un miembro del hogar recibe ingresos escriba los ingresos brutos y mensuales actuales en la columna
apropiada (Ingreso bruto es la cantidad que usted gana antes de impuestos y deducciones).
Sección 5: Escriba el número total de personas que viven en su hogar. Sume los nombres que escribió en las
secciones 3 y 4.
Sección 6: Certificación, Firma (se requiere) y número de Seguro Social
•
Escriba su número de Seguro Social o escriba una “X” si no tiene uno.
•
El número de Seguro Social no se requiere para niños que viven en hogares temporales, o que son
supervisados por los servicios sociales, o para aquellas personas que reciban TANF o Cupones para
Alimentos.
•
Se requiere la firma. La solicitud se rechazará si usted no la firma.
•
Sección 7:
Sección 8:
Sección 9:
Escriba su primer nombre y apellido y la fecha en que usted firmó la solicitud.
Firme si da permiso de que se comparta esta información con otras agencias
Escriba su dirección postal y un número de teléfono donde lo podamos encontrar durante el día.
Es opcional