norristown area school district

1. NORRISTOWN AREA SCHOOL DISTRICT Free and Reduced Price School Meal Family Application 2010-2011 Directions

2. Page 2

3. Who Should Be Included in Your Household? This is a very important question. You must list everyone in your household. A household or family is a group of related or unrelated individuals living together as an economic unit. You must include yourself and all children and family members living with you. (Include babies as well even though they do not attend school – they count as a household member) Be sure to list everyone in your household in Part 1 under Names of household members. Page 3

4. You must complete: Part 1 Skip these parts: Part 2,3,4 You must complete: Part 5 Answer if you choose to: Part 6 Page 4

5. Part 1: List all household members, the school name for each child attending school in the Norristown Area School District, and the case number for any household member (including adults) who is receiving SNAP or TANF benefits (9 digit number – the first 2 digits are the county number and the last 7 are the case number) Providing a single case number for any member of the household will establish eligibility for all children in the family. Page 5

6. Part 2,3,4: Skip these parts Page 6

7. Part 5: Sign and date the form Page 7

8. Part 6: Answer this question if you choose to Page 8

9. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS You must complete: Part 1, 2 Skip this part: Part 3 You must complete: Part 4, 5 Answer if you choose to: Part 6 Page 9

10. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 1: List all household members, the school name for each child attending school in the Norristown Area School District. Page 10

11. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 2: Check the appropriate box and call the Norristown Area School District Homeless Liaison, Migrant Coordinator Jim Lewis at 610-630-5048 Page 11

12. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 3: Skip this part Page 12

13. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 4: Complete only if a child in your household isn’t eligible under homeless, migrant or runaway. (An example of this would be if you have a homeless family living with you and you are providing financial support to the homeless family. The homeless child would go under part 2. You would then list all of the household members including the homeless family and child and their income under part 4) Page 13

14. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 5: Sign the Form. A social security number is not necessary if you didn’t need to fill in part 4. Page 14

15. IF YOU ARE APPLYING FOR A CHILD WHO IS HOMELESS, A MIGRANT, OR RUNAWAY FOLLOW THESE INSTRUCTIONS Part 6: Answer the question if you choose to. Page 15

16. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS You must complete: Part 1 Skip this part: Part 2 You must complete: Part 3 Skip this part: Part 4 You must complete: Part 5 Answer if you choose to: Part 6 Page 16

17. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 1: Use a separate application for each foster child. List the child’s name, school, and, if the child has no income, check the box “no income.” Page 17

18. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 2: Skip this part Page 18

19. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 3: Check the box and list the child’s personal use monthly income, if any on the $______ line. If the child does not have personal use monthly income put a zero on the $______ line. Page 19

20. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 4: Skip this part Page 20

21. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 5: Sign the form. A social security number is not necessary. Page 21

22. IF YOU ARE APPLYING FOR A FOSTER CHILD FOLLOW THESE INSTRUCTIONS Part 6: Answer the question if you choose to. Page 22

23. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS You must complete: Part 1, 2 Skip this part: Part 3 You must complete: Part 4, 5 Answer if you choose to: Part 6 Page 23

24. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 1: List all household members and the school name for each child. For any person, including children and babies with no income, you must check the “No Income Box”. Page 24

25. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 2: Check the appropriate box, if any Page 25

26. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 3: Skip this part Page 26

27. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 4: Follow these instructions to report total household income from this month or last month. Box 1 Name: List all household members with income. Box 2 Gross Income and How Often It Was Received: For each household member that you listed in box 1 of this section, list each type of income received. This is explained on the next two slides. You must write how often the money was received – weekly, every other week, twice a month, or monthly. You must list gross income, not take-home pay. (See following information - types of income) Page 27

28. Types of Income Earnings From Work Before Deductions- list the amount of gross income each person received and how often. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. Welfare, Child Support, Alimony - list the amount each person received for the month from welfare, child support, and/or alimony. Pensions, Retirement, Social Security, SSI, VA Benefits - list the amount each person received for the month from pensions, retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits. All Other Income – list income from Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Page 28

29. Types of Income (CONTINUED) Self Employment - For ONLY the self-employed, under Earnings From Work, report income after expenses. This is for your business, farm, or rental property. Military - If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income. Page 29

30. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 5: An adult household member must sign the application. If Part 4 is completed, the adult signing the form also must list his or her Social Security Number or mark the “I do not have a Social Security Number” box. Page 30

31. ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS (Income Based) FOLLOW THESE INSTRUCTIONS Part 6: Answer this question if you choose to. Page 31

32. Still Have Questions??? If you still have questions please contact the Norristown Area School District Food Service Department at the Administration Building telephone 610-630-5023 Please check to make sure you have the application filled out correctly. Completed applications will be processed in the order in which they are received. Page 32