Paper applications are available at your child's school.
Step 1. Find your household (all members living at your address) size. If the combined monthly gross income of all members is equal to or less than the amount listed, you maybe eligible for Free or Reduced-price School Meals.
Household Size Income Scale for USDA Nutrition Programs
July 1, 2013 to June 30, 2014
|For Each Additional |
Step 2. Fill out Student Information/Part 1. Please print your student's name, ID#, Grade, School, and Food Stamp number (none, if not receiving FS). Complete for all children enrolled in the Madison School District.
Step 3. For Foster or Institutional Student/Part 2. Please check appropriate box. You do not need to fill out an application.
Step 4. Fill out Gross Household Income/Part 3. Please print each member of the household's name, gross (before deductions) income and how many times paid per month in the appropriate column. If the monthly income is equal to zero, please circle No Income in the last column of Part 3.
Step 5. Fill out Household Information/Part 4. The "signer" of the application must be an adult member of the household. Please print and sign name, last four digits of SS# or check the box for none, phone numbers, and address.
Step 6. Racial Identities/Part 5. This section is optional.
Step 7. Turn completed application into your student's school office.
Failure to fully complete all appropriate steps, will cause a delay in the approval of the application and it's available benefits.
If you receive Food Stamps; The District receives a list of students, whose family qualifies for Food Stamps. Those students are now being "Directly Certified" and the families will not need to fill out an application.
If you need any assistance in filling out the free and reduced application, please call your school office or the Food & Nutrition Office at 204-4001. Our Office hours are 6:30am - 3:00pm, Monday through Friday.
Free and Reduced-price School Meal application forms are distributed at registration. If a household member becomes unemployed or, if the household size changes, the family should contact the school to fill out a new application. A household can apply/reapply as many times as needed during a school year.
The information the household adult provides on the application will be used for the purpose of determining eligibility and may be verified at any time during the school year by program officials. The information provided by the household adult on the application is confidential and will be used only for purposes of determining eligibility and verifying data.
Under the provisions of the School Agency's policy for free or reduced-price school meals, the school Principal will review applicaitons and determine eligibilty. If a parent or guardian (household adult) is dissatisfied with the ruling of the official, he/she may wish to discuss the decision with the determing official on an informal basis. If the parent or guardian (household adult) wishes to make a formal appeal, he/she may make a request either orally or in writing to: Steve Youngbauer, Director of Food & Nutriton, 4711 Pflaum Road, Madison, WI 53718-6765, 204-4001. If a hearing is needed to appeal the decision, the policy contains an outline of the hearing procedure. A copy of the policy can be obtained at the school office.
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 Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.
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 last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a FoodShare, W-2 Cash Benefits 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.