HOW TO COMPLETE THE FREE AND REDUCED SCHOOL MEAL APPLICATION
Please complete the Free and Reduced School Meal Application using the instructions below. Sign the form and return it to
School Nutrition 129 Seamon Rd, Farmington Maine, 04938.
If you need help, we will be happy to assist you, please call: (207) 779-9720
SECTION 1 CHILD INFORMATION:
Print your child’s name, grade, room, and school.
List each school age child in the household.
If you receive SNAP or TANF Benefits provide those numbers. Check the foster child box if applicable. Do not put MaineCare numbers here.
***Maine Care does not automatically qualify your student for free/reduced price benefits.*****
SECTION 2 ALL OTHER HOUSEHOLD MEMBERS:
Write the names of everyone in your household other than those listed above in section #1. Include yourself, your spouse, and all other household members.
Write the amount of income each person received last month before taxes or anything else was taken out and where it came from, such as earnings, welfare, pensions, and other income (see the examples below for types of income to report). Each income amount should be entered in the appropriate column on the form. If any amount last month was more or less than usual, write that person’s usual monthly income. See below for types of income to report.
If anyone is self-employed, write the amount of income the person earns from self-employment; for example, income from being a family day care home provider, or operating a farm. Please call the school if you need help.
SECTION 3 SIGNATURE AND LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER
The form must have the signature of an adult household member.
The adult household member who signs the statement must include the last four digits of his/her social security number. If he/she does not have a social security number, check the appropriate box. A social security number is not needed if you listed a SNAP or TANF case number or if you are applying for a foster child.
SECTION 4 OTHER BENEFITS: (Optional)
You may complete this section only if you wish to receive information about Medicaid or Cub Care benefits.
SECTION 5 ETHNIC/RACIAL IDENTITY: (Optional)
You are not required to answer this question to get meal benefits, but completion of this information will help ensure everyone is treated fairly.
INCOME TO REPORT
Earnings from Work
Wages/salaries/tips, Strike benefits, Unemployment compensation, Worker’s compensation, Net income from self-owned business, day care business or farm
Pensions/Retirement/Social Security
Pensions, Supplemental Security Income, Retirement income, Veteran’s payments, Social Security
Other Monthly Income/Self-employment
Disability benefits, Cash withdrawn from savings, Interest/dividends, Income from estates/trusts/investments, Regular contributions from persons not living
in the household, Net royalties/annuities/net rental income, Military allowance for off-base housing, Any other income
Welfare/Child Support/Alimony,
Welfare payments, Alimony/child support payments, Foster child income, Public assistance payments,
I
Please complete the Free and Reduced School Meal Application using the instructions below. Sign the form and return it to
School Nutrition 129 Seamon Rd, Farmington Maine, 04938.
If you need help, we will be happy to assist you, please call: (207) 779-9720
SECTION 1 CHILD INFORMATION:
Print your child’s name, grade, room, and school.
List each school age child in the household.
If you receive SNAP or TANF Benefits provide those numbers. Check the foster child box if applicable. Do not put MaineCare numbers here.
***Maine Care does not automatically qualify your student for free/reduced price benefits.*****
SECTION 2 ALL OTHER HOUSEHOLD MEMBERS:
Write the names of everyone in your household other than those listed above in section #1. Include yourself, your spouse, and all other household members.
Write the amount of income each person received last month before taxes or anything else was taken out and where it came from, such as earnings, welfare, pensions, and other income (see the examples below for types of income to report). Each income amount should be entered in the appropriate column on the form. If any amount last month was more or less than usual, write that person’s usual monthly income. See below for types of income to report.
If anyone is self-employed, write the amount of income the person earns from self-employment; for example, income from being a family day care home provider, or operating a farm. Please call the school if you need help.
SECTION 3 SIGNATURE AND LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER
The form must have the signature of an adult household member.
The adult household member who signs the statement must include the last four digits of his/her social security number. If he/she does not have a social security number, check the appropriate box. A social security number is not needed if you listed a SNAP or TANF case number or if you are applying for a foster child.
SECTION 4 OTHER BENEFITS: (Optional)
You may complete this section only if you wish to receive information about Medicaid or Cub Care benefits.
SECTION 5 ETHNIC/RACIAL IDENTITY: (Optional)
You are not required to answer this question to get meal benefits, but completion of this information will help ensure everyone is treated fairly.
INCOME TO REPORT
Earnings from Work
Wages/salaries/tips, Strike benefits, Unemployment compensation, Worker’s compensation, Net income from self-owned business, day care business or farm
Pensions/Retirement/Social Security
Pensions, Supplemental Security Income, Retirement income, Veteran’s payments, Social Security
Other Monthly Income/Self-employment
Disability benefits, Cash withdrawn from savings, Interest/dividends, Income from estates/trusts/investments, Regular contributions from persons not living
in the household, Net royalties/annuities/net rental income, Military allowance for off-base housing, Any other income
Welfare/Child Support/Alimony,
Welfare payments, Alimony/child support payments, Foster child income, Public assistance payments,
I
