Instructions for Applying

Complete an application if one or more of the following apply to your household:

  • Any member of the household currently participates in any of these three programs: Minnesota Family Investment Program (MFIP), Food Support (SNAP), or Food Distribution Program on Indian Reservations (FDPIR).
  • One or more children in the household are foster children (a welfare agency or court has legal responsibility for the child).
  • Total household income (gross earnings, not take-home pay) is within these guidelines:

Household SizeYearlyMonthlyWeekly
122,311 1,860430
230,0442,504578
337,7773,149727
445,5103,793876
553,2434,4371,024
660,9765,0821,173
768,7095,7261,322
876,4426,3711,471
Each Additional
7,7336,371149

Section 1. Check the box if this is the first time that you have applied for meal benefits for any of your children at this school district or nonpublic school.

  • List all children in the household, including foster children, and provide the requested information for each child. Birthdate, School, and Grade are not required fields.
  • Foster children: check the "foster child" box for each child who is a foster child (a welfare agency or court has legal responsibility for the child). If all children who need to be approved for school meal benefits are foster children, skip sections 2 and 3.

Section 2. If any member of the household receives public assistance from any of the following three programs, provide the person's name and case number: Minnesota Family Investment Program (MFIP), Food Support (SNAP), or Food Distribution Program on Indian Reservations (FDPIR). If section 2 is completed, skip section 3. A Medical Assistance number does not qualify for this purpose.

Section 3. Provide all household members and all incomes. List any regular incomes to children such as SSI payments or regular earnings. Do not list occasional earnings like babysitting. Include all adult persons who live in the household whether related or not. Also include any persons who are temporarily away, such as a student away at college.

  • For earnings, list gross income before taxes and other deductions, not take home pay. You should be able to find your gross income on your pay stub. For farm/self-employment income only, list net income after business expenses. Provide how often each income is received: Weekly (W), Bi-Weekly (every other month) (BW), Twice per Month (TM), or Monthly (M). Do not Provide an hourly wage.
  • Examples of "other income" to include in the last column are farm or self-employment income, Veterans (VA) benefits, and disability benefits.
  • Do not include as income: foster care payments, federal education benefits, or assistance provided by MFIP, Food Support (SNAP), WIC or FDPIR. Military: Do not include income from the Military Privatized Housing Initiative or combat pay.

Section 4. The form must be signed by an adult household member. If section 3 of the application has been completed, the signer must provide the last four digits of their Social Security Number unless they indicate that they do not have a Social Security Number. Provide address and phone number to assist in processing your application.

Section 5. Leave these boxes blank if you want to share your school meal eligibility status with these health benefit/insurance programs. Check the boxes if you do not want to share your eligibility status with these programs.

Section 6. Please provide voluntary racial/ethnic information.

Letter to Parents

Dear Parent/Guardian:

Our school provides healthy meals each day. Breakfast costs Breakfast [$]; lunch costs Lunch [$].

Your children may qualify for free or reduced-price meals. Reduced price is Reduced Lunch [$] for lunch. "Reduced-price" breakfasts are served at no charge. To apply for free or reduced-price school meals, complete the enclosed Application for Educational Benefits following the instructions. A new application must be submitted each year. Your application also helps our school qualify for additional education funds and discounts.

Who can get free or reduced-price meals? Children in households participating in Food Support (SNAP), Minnesota Family Investment Program (MFIP), or Food Distribution Program on Indian Reservations (FDPIR) and foster children can get free school meals without reporting household income. Also, children can get free or reduced-price meals if their household income is within the maximum income shown for the household size. An application must be submitted each school year.

Can foster children get free meals? Yes, foster children who are the legal responsibility of a foster care agency or court are eligible for free meals regardless of household income.

I get WIC. Can my children get free meals? Children in households participating in WIC may be eligible for free or reduced-price meals. Please fill out an application.

May I apply if someone in my household is not a U.S. citizen? Yes. You or your children do not have to be U.S. citizens for your children to qualify for free or reduced-price meals.

If I don’t qualify now, may I apply later? Yes. You may apply at any time during the school year if your income goes down, household size goes up, or if you start getting Food Support (SNAP), MFIP, or FDPIR benefits.

Who should I include as members of my household? Include yourself and all other people living in the household, related or not (such as grandparents, other relatives or friends). Include a household member who is temporarily away, such as a college student. Do not include a person who is economically independent and pays their full pro-rated share of all expenses.

What if my income is not always the same? List the amount that you normally get. If you normally get overtime, include it, but not if you get it only sometimes.

Are military housing and supplemental allowances counted as income? Do not include any housing allowance from the Military Housing Privatization Initiative or a Family Subsistence Supplemental Allowance. Include the portion of a deployed service member’s income that is made available to the household, except do not include combat pay or Deployment Extension Incentive Pay.

How will the information I provide be kept? Information you provide on the form, and your child’s approval for school meal benefits, will be protected as private data. See the Application for Educational Benefits for more information.

Will the information I give be checked? Yes and we may also ask you to send written proof.

What if I disagree with the school’s decision about my application? You should talk to school officials. You also may ask for a hearing.

Do I need to notify school officials if my income increases or my household size decreases after I have qualified for free or reduced-price meals? No. Approval for free or reduced-price meals is good for the school year unless the household has received a temporary approval for school meal benefits.

If you have other questions or need help, call 763-389-6262

Sincerely,

Deanna Cooley

Federal Income Chart

Household SizeYearlyMonthlyWeekly
122,3111,860430
230,0442,504578
337,7773,149727
445,5103,793876
553,2434,4371,024
660,9765,0821,173
768,7095,7261,322
876,4426,3711,471
Each Additional
7,7336,371149

Privacy Act Statement

The National School Lunch Act requires that the household member signing the application must provide the last four digits of their Social Security Number unless an active Minnesota Family Investment Program (MFIP), Food Support (SNAP) or Food Distribution Program on Indian Reservations (FDPIR) assistance number is supplied for your child, or you are applying for a foster child, or you do not have a Social Security Number. Provision of a Social Security Number is not mandatory, but if a Social Security Number is not given or an indication is not made that the signer does not have such a number, the application cannot be approved.

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. At public school districts, each student's eligibility status is also recorded on a statewide computer system used to report student data to the Minnesota Department of Education as required by state law. The Minnesota Department of Education uses this information to: (1) administer state and federal programs; (2) calculate compensatory revenue for public schools; and, (3) judge the quality of the state's educational program.

Sharing Information with MinnesotaCare and General Assistance Medical Care Programs

Children who are eligible for free and reduced-price school meals may be eligible for Minnesota health insurance programs. Your child's eligibility status for school meals (qualified for free or reduced-price meals) may be shared with the MinnesotaCare and General Assistance Medical Care programs unless you tell us not to share your information by checking the boxes in section 5 of the application. You are not required to share information for this purpose and your decision will not affect approval for school meal benefits.

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: http://www.ascr.usda.gov/complaint_filing_cust.html, 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.