INDIAN RIVER SCHOOL DISTRICT

31 Hosier Street, Selbyville, DE 19975

(302) 436-1000

 

Dear Parent/Guardian:

The Indian River School District offers a choice of healthy meals each school day. High school and middle school students may buy lunch for $1.10 and elementary school students may buy lunch for $1.00. All students may buy breakfast for $.60. Children who qualify under U.S. Department of Agriculture guidelines may get meals free or at a reduced price of $.40 for lunch and $.30 for breakfast. All meals served must meet nutrition standards established by the U.S. Department of Agriculture. If a child has a disability as determined by a doctor and the disability prevents the child from eating the regular school meal, the school will make substitutions prescribed by the doctor. If a substitution is needed, there will be no extra charge for the meal. Please note however that the school is not required to make a substitution for a food allergy, unless it meets the definition of disability. Please call the school for further information.

Your child can get free school meals if you receive food stamps or receive benefits from Delaware’s TANF Program. If your household’s total gross income is the same or below the amount on the Income Chart, your child can get meals either free or at a reduced price.

1.

 		 

Do I need to fill out a meal benefit form for each child? No. Complete the meal benefit form to apply for free or reduced price meals. Use one Family Meal Benefit Form for all students in your household. We cannot approve a form that is not complete, so be sure to fill out all required information. Return the completed form to the school.

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? Please call the school to see if your child(ren) qualify if you have not been informed that they will get free meals.

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 the form.

5.

 		 

Should I fill out a form if I got a letter this school year saying my children are approved for free or reduced price meals? Please carefully read the letter and follow the instructions. Call 436-1000 ext. 141 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 a form.

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 getting 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 form? You should talk to the nutrition services supervisor. You may also ask for a hearing by calling or writing to (302) 436-1000 or Dr. Susan Bunting, Superintendent, 31 Hosier Street, Selbyville, DE 19975.

10.

 		 

May I apply if someone in my household is not a U.S. citizen? Yes. You or your child(ren) do not have to be a U.S. 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. Do not include overtime if you only get overtime sometimes.

If you have other questions or need help, call 436-1000 ext. 141. Si necesita ayuda, por favor llame al telelfono: 436-1000 ext. 141. Si vous voudriez d’aide, contactez nous au numero: 436-1000 ext. 141.

Sincerely,

 

Joseph I. Headman, Jr.

Nutrition Services Supervisor

 

INCOME CHART

Effective July 1, 2006 to June 30, 2007

REDUCED MEALS – 185%

Household Size

Annual

Month

Week

1

$

18,130

$

1,511

$

349

2

$

24,420

$

2,035

$

470

3

$

30,710

$

2,560

$

591

4

$

37,000

$

3,084

$

712

5

$

43,290

$

3,608

$

833

6

$

49,580

$

4,132

$

954

7

$

55,870

$

4,656

$

1,075

8

$

62,160

$

5,180

$

1,196

For each additional household member, add the following:

+$

6,290

+$

525

+$

121

 

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 form. 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 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 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, gender, 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.

 

Meal Benefit Form Letter 2006-07.doc

 

 

MEAL BENEFIT FORM INSTRUCTIONS

USE ONE MEAL BENEFIT FORM PER HOUSEHOLD FOR ALL STUDENTS IN THE INDIAN RIVER SCHOOL DISTRICT. Incomplete Meal Benefit Forms cannot be approved for benefits.

To apply for free and reduced price meals, complete the meal benefit form using the instructions for your household. Sign the meal benefit form and return the meal benefit form to the school. If you need help, telephone Mr. Headman at (302) 436-1000, ext. 141.

 

If your household gets FOOD STAMPS OR DE-TANF, follow these instructions if you have not received a letter before the second week of school stating all of your children have already been approved for free meals.

Part 1

Print the name(s) of all children you are applying for. List the children's school and grade. Also list children in kindergarten or preschool.

 

List a current food stamp or DE-TANF case number for each child. We need the ten-digit case number, not the EBT number on your ID card. Contact your worker if you do not have the case number.

Part 2

Check the appropriate box, if any.

Part 3

Skip this part.

Part 4

Skip this part.

Part 5

An adult household member must sign the meal benefit form. A Social Security number is requested, but not necessary. Indicate your current home mailing address and phone number.

 

If you have a HOMELESS, MIGRANT, OR RUNAWAY CHILD, check the appropriate box in Part 2 and contact the school or appropriate district coordinator. Fill out the application by following instructions for All OTHER HOUSEHOLDS.

 

If you are applying for a FOSTER CHILD, follow these instructions. A foster child is the legal responsibility of a DSCYF agency or court.

Part 1

Use a separate meal benefit form for each foster child. List the child’s name, school and grade.

Part 2

Skip this part.

Part 3

List the foster child's monthly "personal use" income. Write "0" if the foster child does not get "personal use" income. "Personal use" income is (a) money given by the DSCYF office identified by category for the child's personal use, such as for clothing, school fees, and allowances; and (b) all other money the child gets, such as money from his/her family and money from the child's full time or regular part time jobs

Part 4

Skip this part. Do not list any other children, household members or income.

Part 5

A foster parent or other official representing the child must sign the meal benefit form. A Social Security number is not required. Indicate your current mailing address and phone number.

 

ALL OTHER HOUSEHOLDS, including WIC households, follow these instructions:

Part 1

Print the name(s) of all children you are applying for. List the children's school and grade. Also list children in kindergarten or preschool..

Part 2

Check the appropriate box, if any.

Part 3

Skip this part.

Part 4

Follow these instructions to report total household income from last month. Examples of income to report are listed on the next page.

First column

NAMES OF HOUSEHOLD MEMBERS: Print the last and first name of each person living in your household, related or not (such as grandparents, other relatives, or friends). You must include yourself and all children living with you (even children not in school). Attach another sheet of paper if necessary.

Second column

Gross Earnings From Work (Before Deductions) and how often it was received: Next to the person’s name, list the gross income each person earned from work. This is not the same as take-home pay. Gross income is the amount earned before taxes and other deductions. The amount should be listed on your pay stub, or your boss can tell you. Next to the amount, write how often the person got it (weekly, every other week, twice a month, or monthly).

Third column

Any Other Income: List the amount of gross income each person got last month from other jobs or other sources. Report net income for self-owned business, farm or rental income. Next to the amount, write how often the person got it.

Fourth column

Public Assistance Payments, Child Support, Alimony: List the amount of income each person got last month from public assistance, child support, and alimony. Next to the amount, write how often the person got it.

Fifth column

Income from Pension, Retirement, and Social Security: List the amount of income each person got last month from pension, retirement, and Social Security. Next to the amount, write how often the person got it.

Sixth column

Check if NO income: If the person does not have any income, check the box.

Part 5

An adult household member must sign the meal benefit form and list his/her Social Security number, or mark the box if he or she does not have one. List your current mailing address and phone numbers.

Part 6

RACI RACIAL/ETHNIC IDENTITY: Answer this question if you choose to.

WAIVER OF CONFIDENTIALITY: This information is located on the back of the meal benefit form. The Indian River School District has written assurances that the entities receiving the information about the child will limit the use of such information to the purposes specified by the household. This is to ensure that the entities receiving the information respect the household's rights of privacy by using the information only for the purposes agreed to. Each year our district receives federal money based upon the number of children who come from families who receive food stamps, free or reduced price meals, or other federal assistance. The money is used to provide certain health benefits, reading assistance, vocational/technical programs, and job training programs. Although your child may not participate in any of these programs, it is still important for us to be able to provide this information to the appropriate entities in order to ensure maximum funding for the district for these programs. Please check YES, sign, and date the Waiver of Confidentiality form if you wish to allow us to do this.

 

 

INCOME TO REPORT

Earnings from Work

Other Monthly Income/Self-employment
 

Wages/Salaries/Tips

Earnings from second Job
 

Strike Benefits
 

Unemployment Compensation
 

Worker's Compensation

Interest/Dividends
 

Net Income from Self-Owned Business,

Income from Estates/Trusts/Investments
 

Day Care Business or Farm

Net Royalties/Annuities/Net Rental Income
    Regular contributions from persons not living in the household

Pensions/Retirement/Social Security

Any other monies available to pay for the child’s meals

Pensions

 

Retirement Income

Public Assistance/Child Support/Alimony
 

Social Security

Public Assistance Payments
 

Veteran’s Payments

  

Welfare Payments
 

Supplemental Security Income

Alimony/Child Support Payments

Meal Benefit Form Instructions.doc Updated July 2006

Meal Benefit Form

You can open this file and print it out to fill in the information or you can save it to your computer, type in your information, and print out.  You must then sign and bring the completed form to school.

 

Click to open or save Meal Benefit Form 2006 - IRSD mine.zip