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.
|Family (Household) Size||Annual Income Level||Monthly Income Level|
|Free||Reduced Price||Free||Reduced Price|
|must be at or below||must be at or between||must be at or below||must be at or between|
|1||$15,678||$15,678.01 and $22,311||$1,307||$1,307.01 and $1,860|
|2||21,112||21,112.01 and 30,044||1,760||1,760.01 and 2,504|
|3||26,546||26,546.01 and 37,777||2,213||2,213.01 and 3,149|
|4||31,980||26,546.01 and 37,777||2,665||2,665.01 and 3,793|
|5||37,414||37,414.01 and 53,243||3,118||3,118.01 and 4,437|
|6||42,848||37,414.01 and 53,243||3,571||3,571.01 and 5,082|
|7||48,282||48,282.01 and 68,709||4,024||4,024.01 and 5,726|
|8||48,282||53,716.01 and 76,442||4,447||4,447.01 and 6,371|
|For each additional household member, add||+5,434||+5,434 and +7,733||+453||+453 and +645|
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. Please communicate with your school. Some paper work may be required.
Step 4. Fill out Gross Household Income/Part 3. Please print each member of the household's name, gross (before all deductions) income and how many times paid per month in the appropriate column. If the monthly income is equal to zero, please indicate with a zero. 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. Make sure at the end of the application process a printable page with your web confirmation number appears. Please print for your records. If this page doesn't appear, please repeat.
Failure to fully complete all appropriate steps, will cause a delay in the approval of the application and its available benefits.
If you receive Food Stamps (Food Stamps); MMSD periodically does an electronic process which automatically qualifes students who are on the SNAP list. Those students are now "Directly Certified" and the families do not need to fill out an application. If you've received notification for one student and not other students, call 204-4001. It is advisable to complete the Free and Reduced-price meals application if you have not received notification that your student has qualified.
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.
If a household member becomes unemployed or, if the household size changes, the family should fill out a new application or call 204-4001. 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.
Under the provisions of the School Agency's policy for free or reduced-price school meals, the district will review applicaitions 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.
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.
The U.S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at firstname.lastname@example.org.
Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).