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Application – Income Eligibility

The following forms are used in the process of approving households for meal benefits.

Attachment A Income Eligibility Guidelines 2025
Attachment B – Letter to Households 2025
Spanish Version Attachment B – Letter to Household 2025
Attachment B-1 – Special Milk Program Letter to Households 2025
Attachment C – Free and Reduced Price Meal Application 2025
Spanish Version Attachment C – Free and Reduced Price Meal Application 2025
Attachment C-1 – Free Milk Application 2025
Attachment D – Approval-Denial Letter 2025
Spanish Version Attachment D – Approval-Denial Letter 2025
Attachment D-1 – Special Milk Program Approval-Denial Letter 2025
Attachment D-3 – Notice for Change of Benefits 2025
Spanish Version Attachment D-3 – Notice of Change in Benefits 2025
Attachment E- Self Employment 2025
Spanish Version Attachment E – Self Employment 2025
Attachment I – Onsite Review for Lunch & Breakfast Program
Attachment I-1 – Onsite Review for Afterschool Snack
Attachment J – Edit Check Worksheet
Attachment J for RCCI – Edit Check Worksheet
Attachment L – Sharing Information Waiver 2025
Spanish Version Attachment L – Sharing Information Waiver 2025
Attachment L-1 – Medicaid Sharing Information Waiver 2025

Updated August 15, 2024 9:51am

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