Please use these instructions to help you fill out the application for free or reduced price school meals/milk. You only need to submit one application per household, even if your children attend more than one school in East Buchanan School District. Please follow these instructions in order. Each step of the instructions is the same as the steps on your application. The application must be filled out completely to certify your children for free or reduced price school meals. Completed applications should be mailed or returned to East Buchanan School District, 414 5th St. N., Winthrop, IA 50682. If at any time you are not sure what to do next, please East Buchanan School, Mellisa Schweitzer; 319-935-3767 or mschweitzer@east-buc.k12.ia.us
PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY.
STEP 1: List all household members who are infants, children, and students up to and including grade 12.
Tell us how many infants, children, and school students live in your household. They do NOT have to be related to you to be a part of your household.
Who should I list here?
When filling out this section, please indicate all members in your household who are:
- Children age 18 or under and are supported with the household's income;
- In your case under a foster arrangement, or qualify as homeless, migrant, or runaway youth;
- Students attending East Buchanan School District, regardless of age.
- List each child’s name and date of birth. Print each child’s first name, middle initial, last name and date of birth (optional). Use one line of the application for each child. If there are more children present than lines on the application, attach a Supplemental Worksheet, which can be obtained from the school, with all required information for the additional children.
- Is the child a student? Mark ‘Yes’ or ‘No’ under the column titled “student” to tell us which children attend East Buchanan School District. If you marked ‘Yes’ write where the child attends school and write the grade level of the student in the “Grade” column to the right.
- Do you have any foster children? If any children listed are foster children, mark the “Foster Child” box next to the child’s name. If you are ONLY applying for foster children, after finishing STEP 1, go to “STEP 4”. Foster children who live with you may count as members of your household and should be listed on your application. If you are applying for both foster and non-foster children, go to step 3.
- Are any children homeless, migrant, or runaway? If you believe any child listed in this section may meet this description, mark the “Homeless, Migrant, Runaway” box next to the child’s name and complete all steps of the application.
STEP 2: Do any household members currently participate in food assistance, FIP, or FDPIR?
If anyone in your household (including you) currently participate in one or more of the assistance programs listed below, your children are eligible for free school meals:
- The Food Assistance Program (FA)
- The Family Investment Program (FIP)
- The Distribution Program on Indian Reservations (FDPIR)
- IF NO ONE IN YOUR HOUSEHOLD PARTICIPATES IN ANY OF THE ABOVE LISTED PROGRAMS: Circle ‘NO’ and go to STEP 3. (Leave the rest of STEP 2 blank)
- IF ANYONE IN YOUR HOUSEHOLD PARTICIPATES IN ANY OF THE ABOVE LISTED PROGRAMS: Circle ‘YES’ and provide a case number for FA, FIP, or FDPIR. You only need to write one case number. If you participate in one of these programs and do not know your case number, it is located on your Notice of Decision. You must provide a case number on your application if you circled “YES”. Go to STEP 4.
STEP 3: Report income for all household members
Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents.
- Gross income is the total income received before taxes.
- Many people think of income as the amount they "take home" and not the total, "gross" amount. Make sure that the income you report on this application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay.
- Write an "0" in any field where there is no income to report. Any income fields left empty or blank will also be counted as a zero. If you write "0" or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials have known or available information that your household income was reportedly incorrectly, your application will be investigated.
- Mark how often each type of income is received using the check boxes to the right of each field.
- Report all income earned or received by children. Refer to the table below titled “Sources of Income for Children” and report the combined gross income for ALL children listed in Step 1 in your household in the box marked “Total Child Income.” Only count foster children’s income if you are applying for them with the rest of your household (income from a part-time job or from any funds provided to the child for the child’s personal use). It is optional for the household to list foster children living with them as part of the household on an application for non-foster children.
What is child income? Child income is money received from outside your household that is paid directly to your child. Many households do not have any child income. Use the chart below to determine if your household has child income to report.
Table 1. Sources of Income for Children
- FOR EACH ADULT HOUSEHOLD MEMBER:
List Adult Household member’s name. Print the name of each household member in the boxes marked“ Name of Adult Household Members (First and Last).” Do not list any household members you listed in STEP 1.
Who should I list here?- When filling out this section, please include all adult members in your household who are:
- living with you and share income and expenses, even if not related and even if they don not receive income of their own.
- Do NOT include:
- People who live with you but are not supported by your household's income AND do not contribute income to your household.
- children and students already listed in Step 1
- When filling out this section, please include all adult members in your household who are:
- Report earnings from work. Refer to the chart below titled “Sources of Income for Adults” and report all income from work in the “Earnings from Work” field on the application. This is usually the money received from working at jobs. If you are self-employed business or farm owner, you will report your net income. If you need assistance with this, ask your children’s school for the Supplemental Worksheet which has self-employment calculations.
What if I am self-employed? If you are self-employed, report income from work as a net amount. This is calculated by subtracting the total operating expenses of your business from its gross receipts and revenue. Ask your school for a Supplemental Worksheet to assist you in determining your monthly gross annual income before deductions. - Report income from public assistance/child support/alimony. Refer to the chart below titled “Sources of Income for Adults” and report all income that applies in the “Public Assistance/Child Support/Alimony” field on the application. Do not report the value of any cash value public assistance benefits NOT listed on the chart. If income is received from child support or alimony, only report court-ordered payments. Informal but regular payments should be reported as “other” income in the next part.
- Report income from pensions/retirement/all other income. Refer to Table 2 below titled “Sources of Income for Adults” and report all income that applies in the “Pensions/Retirement/All Other Income” field on the application.
Table 2. Sources of Income for Adults- Earning from Work
- Salary, wages, cash bonuses
- Net income from self-employment (farm or business)
- If you are in the U.S. Military:
- Basic pay and cash bonuses (do NOT include combat pay, FSSA or privatized housing allowances)
- Allowances for off-base housing, food and clothing
- Public Assistance/ Alimony/Child Support
- Unemployment benefits
- Worker’s compensation
- Supplemental Security Income (SSI)
- Cash assistance from State or local government
- Alimony payments
- Child support payments
- Veteran’s benefits
- Strike benefits
- Pensions/Retirement/All Other Income
- Social Security (including railroad retirement and black lung benefits)
- Private Pensions or disability benefits
- Regular Income from trusts or estates
- Annuities
- Investment Income
- Earned interest
- Rental income
- Regular cash payments from outside household
- Earning from Work
- Report total household size. Enter the total number of household members in the field “Total Household Members (Children and Adults).” This number MUST be equal to the number of household members listed in STEP 1 and STEP 3. If there are any members of your household that you have not listed on the application, go back and add them. It is very important to list all household members, as the size of your household affects your eligibility for free and reduced price meals.
- Provide the last four digits of your Social Security Number. An adult household member must enter the last four digits of their Social Security Number in the space provided. You are eligible to apply for benefits even if you do not have a Social Security Number. If no adult household members have a Social security Number, leave this space blank and mark the box to the right labeled “Check if no SSN.”
STEP 4: Contact Information and Adult Signature
All applications must be signed by an adult member of the household. By signing the application, that household member is promising that all information has been truthfully and completely reported. Before completing this section, please also make sure you have read the privacy and civil rights statements on the back of the application.
- Provide your contact information. Write your current address in the fields provided if this information is available. If you have no permanent address, this does not make your children ineligible for free or reduced price school meals. Sharing a phone number, email address, or both is optional, but helps us reach you quickly if we need to contact you.
- Print and sign your name and write today’s date. Print the name of the adult signing the application and that person signs in the box. “Signature of adult completing the form.”
- Mail or return completed form to East Buchanan School District, 414 5th St. N., Winthrop, IA 50682. Please do not mail completed form to the Department of Agriculture as this will delay processing.
- Share children’s racial and ethnic identities (optional). On the back of the application, we ask you to share information about your children’s race and ethnicity. This field is optional and does not affect your children’s eligibility for free or reduced price school meals. If you do not select race or ethnicity, one will be selected for you based on visual observation.
- Decline having your information released to hawk-i . If you do not want your household information shared with hawk-i , print, sign and date in the box provided.
- Obtaining translated applications. If you need a translated application with instructions, they can be found in 49 languages at: https://www.fns.usda.gov/school-meals/translated-applications..