FAMILY
APPLICATION FOR FREE AND REDUCED PRICE MEALS 2022-2023 SCHOOL YEAR
Waller
ISD School Nutrition Services
1918
Key Street Waller
Texas 77484 (936) 931.2347
Dear Parent or
Guardian:
Waller
ISD participates in the National School Lunch Program and School Breakfast
Program and offers nutritious meals daily. Breakfast at ALL schools is FREE for
all students; elementary lunch is $2.10 and junior high and high school is $2.35.
Your children may qualify for free or reduced-price meals. Reduced priced lunch
is $.40, there is no charge for breakfast.
INCOMPLETE, ILLEGIBLE, OR INCORRECT APPLICTAIONS
WILL DELAY MEAL BENEFITS |
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SUBMIT:
Complete
ONE application to apply for free or reduced-price meals. Use ONE meal application for all
students in your household. We cannot approve applications that are
not complete, so be sure to fill out all required information. Return the completed application to:
Waller ISD School Nutrition Services 1918 Key Street Waller Texas 77484, Fax:
(936) 931-4047, email: rboleman@wallerisd.net or to your child’s school. |
REPORTING
INCOME: If
your income is not always the same, list the amount that you normally
receive. For example, if you normally get paid $1,000 each month, but you
missed work last month and only got $900, put down that you get $1,000 per
month. If you normally get overtime pay, include that amount as income. If
you get overtime pay sometimes, do not include it as income. If your housing
is part of the Military Housing Privatization Initiative, do not include your
housing allowance as income. All other income must be included in your GROSS
income before deductions. |
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NOTICE:
Children
in households that receive 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 Service
Commission (HHSC) is your documentation for free meals. You may take your
HHSC letter to Waller ISD School Nutrition Services Department to be directly
certified for free meals. If your household received a letter sent from the
Waller ISD School Nutrition Services that states your child(ren) is/are
directly qualified to receive free meals, be sure all of the children in the
household are listed on the letter. If there are students not listed on the
letter, please contact the School Nutrition Services Department at
936.931.2347. If you believe the child for whom you are applying is homeless,
migrant, or runaway, contact Dean Guerra, Homeless Liaison,
936.372.0161 Approval
of free or reduced price meals is good for the entire school year, plus 30
calendar days into the next school year. A new application must be
completed every year. |
VERIFICATION: Your
eligibility may be checked at any time during the school year. School
officials may ask you to send records proving that your child is eligible to
receive free or reduced-price meals. 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 your social security number of the adult household
member who signs the application. The last four digits of the social security
number are not required when you apply on behalf of a foster child or you
list a SNAP, TANF or Food Distribution Program on Indian Reservations (FDPIR)
number OR when you indicate 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 the 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. |
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FOSTER
CHILD(REN): A
foster child is eligible for free meals. This eligibility must be given to
any foster child whose care and placement is the responsibility of the Texas
Dept. of Family and Protective Services (DFPS) or who is placed by the court
with a caretaker household. Households with foster and non-foster children
may choose to include the foster child as a household member, as well as any
personal income earned by the foster child on the same application with their
non-foster children. In processing the application, we would certify the
foster child eligible for free meals, and then make an eligibility
determination for the remainder of the household based on the household’s
income (including personal income earned by the foster child) or any other
information reported on the application. Foster payments received by the
family from the placing agency are NOT considered income and do not need to
be reported. NOTE: The presence of
a foster child in the household does NOT convey eligibility for free meals to
all children in the household. |
Non-discrimination Statement: In accordance with Federal civil
rights law and U.S. Department of Agriculture (USDA) civil rights regulations
and policies, the USDA, its Agencies, offices, and employees, and
institutions participating in or administering USDA programs are prohibited
from discriminating based on race, color, national origin, sex, disability,
age, or reprisal or retaliation for prior civil rights activity in any
program or activity conducted or funded by USDA. Persons with disabilities who require
alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign
Language, etc.), should contact the Agency (State or local) where they
applied for benefits. Individuals who
are deaf, hard of hearing or have speech disabilities may contact USDA
through the Federal Relay Service at (800) 877-8339. Additionally, program information may be
made available in languages other than English. To file a
program complaint of discrimination, complete the USDA
Program Discrimination Complaint Form, (AD-3027) found online at: https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint, and at any USDA office, or write a
letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866)
632-9992. Submit your completed form
or letter to USDA by: (1) mail: U.S. Department of Agriculture , Office of
the Assistant Secretary for Civil Rights ; 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202)
690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity
provider. |
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APPLY
FOR BENEFITS: You
may apply for a benefit at any time during the school year if your household
size goes up, income goes down, or if you start receiving SNAP, TANF or other
benefits or if the parent or guardian becomes unemployed. Children in
households participating in WIC may be eligible for free or reduced-priced
meals. Please fill out an application. You or your child(ren) do not have to
be a U.S. citizen to apply or qualify for free or reduced-price meals. |
FAIR HEARING: If you disagree
with the district’s decision regarding your application, or the result of
verification, you have the right to a fair hearing by calling or writing to: Molly
Warzon, Executive Director of Auxiliary Services, 2214
Waller Street, Waller, Texas 77484, 936.931.0307. |
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HOW TO FILL OUT THIS APPLICATION – PLEASE PRINT
NEATLY WITH BLACK OR BLUE INK. PLEASE USE CAPITAL LETTERS. COMPLETE ONE APPLICATION
PER HOUSEHOLD. |
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Part
1- If
anyone in the household receives SNAP or TANF, enter the eligibility group
number in the boxes. Lone Star card numbers are not accepted. If the
household enters an EDG number, complete part 2 and 4. Part
2 – Enter
the enrolled student’s ID (if you know it), first name, last name, grade and
the name of the school they attend. Check the box if the child is a foster
child, homeless, migrant or runaway. Part
3 – Enter
the names of ALL members living in your household except students listed in
part 2. You must include yourself and all people living in your household,
related or not (such as grandchildren, children, grandparents, other
relatives or friends). Household means a group of related, or non-related,
individuals who are living as one economic unit and sharing living expenses
to include: rent, clothes, food, doctor bills, and utility bills. Households
with deployed service members should include their name and the income made
available to the household. Enter the income BEFORE DEDUCTIONS in the appropriate column. Indicate how often
that income is received in the box marked “Frequency”. Enter (W) if the
income is received weekly; (E) if income is received every other week; (T) if
income is receive twice a month; (M) if the income
is received monthly and (A) if the income is received annually. 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, regular contributions from
people who do not live in your household and ANY OTHER INCOME. Report net income for self-owned businesses
farm or rental income. Next to the amount, write how often the person
receives it. 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, excluding combat pay. Part
4 – The
adult filling out the application must SIGN
and PRINT their name and the
date signed. Enter your mailing address and telephone number. While
disclosure of the last 4 digits of a Social Security number is voluntary, the
National School Lunch Act requires the last 4 digits of a Social Security
number or an indication of “none” for approval of the application. |
Part 5 – An adult
household member must enter the last
four digits of their Social Security Number. If the adult household
member does not have a Social Security Number, place an X in the box
provided. The Social Security number
is not required if a SNAP or TANF number is listed in part 1. If your income
falls within the limits on this chart, your child(ren) may qualify for free
or reduced price meals.
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