Little Cypress Mauriceville CISD announced its policy today for providing free and reduced-price meals for children served under the attached current income eligibility guidelines. Each school/site or the central office has a copy of the policy, which may be reviewed by anyone on request.

Starting on August 1, will begin distributing letters to the households of the children in the district about eligibility benefits and any actions households need to take to apply for these benefits. Applications also are available at each school office and the Administration Office located at 6586 FM 1130 Orange, Texas 77632.

Criteria for Free and Reduced-Price Meal Benefits

The following criteria will be used to determine a child’s eligibility for free or reduced-price meal benefits:

Income

  1. Household income that is at or below the income eligibility levels

Categorical or Automatic Eligibility

  1. Household receiving Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF); or Food Distribution Program on Indian Reservations (FDPIR)

Program Participant

  1. Child’s status as a foster child, homeless, runaway, migrant, or displaced by a declared disaster
  2. Child’s enrollment in Head Start or Even Start

Income Eligibility

For those households that qualify for free or reduced-price meals based on income, an adult in the household must fill out free and reduced-price meal application and return it Charlotte McShan, Child Nutrition Secretary located at the LCMCISD Administration office, phone number 409-883-2232 extension 2390 or 2440. Those individuals filling out the application will need to provide the following information:

  1. Names of all household members
  2. Amount, frequency, and source of current income for each household member
  3. Last 4 digits of the Social Security number of the adult household member who signs the application or, if the adult does not have a social security number, check the box for

“No Social Security number”

  1. Signature of an adult household member attesting that the information provided is correct

Categorical or Program Eligibility

Little Cypress Mauriceville CISD is working with local agencies to identify all children who are categorically and program eligible. Little Cypress Mauriceville CISD will notify the households of these children that they do not need to complete an application. Any household that does not receive a letter and feels it should have should contact {insert name, title, and contact information}.

Any household that wishes to decline benefits should contact Charlotte McShan, Child Nutrition Secretary located at the LCMCISD Administration office, phone number 409-883-2232 extension 2390 or 2440.

Applications may be submitted anytime during the school year. The information households provide on the application will be used for the purpose of determining eligibility. Applications may also be verified by the school officials at any time during the school year.

Determining Eligibility

Under the provisions of the free and reduced-price meal policy, Charlotte McShan, Child Nutrition Secretary will review applications and determine eligibility. Households or guardians dissatisfied with the Reviewing Official’s eligibility determination may wish to discuss the decision with the Reviewing Official on an informal basis. Households wishing to make a formal appeal for a hearing on the decision may make a request either orally or in writing to Dr. Pauline Hargove, Superintendent located at the LCMCISD Administration office, phone number 409-883-2232.

Unexpected Circumstances

If a household member becomes unemployed or if the household size increases, the household should contact the school. Such changes may make the children of the household eligible for benefits if the household’s income falls at or below the attached current income eligibility guidelines.

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.

Little Cypress Mauriceville CISD

Dear Parent/Guardian:

Children need healthy meals to learn. Little Cypress Mauriceville CISD offers healthy meals every school day. Breakfast costs $2 for Elementary & Middle School students, $2.25 for High School; lunch costs $2.55 for Elementary, $2.80 for Middle & Junior High, and $3.05 for High School. Your children may qualify for free meals or for reduced-price meals. Reduced-price is 30 cents for breakfast and 40 cents for lunch. If you received a notification letter that a child is directly certified for free meals, do not complete an application. Let the school know if any children in the household attending school are not listed in the letter.

  1. The questions and answers that follow and attached directions provide additional information on how to complete the application. Complete only one application for all the students in the household and return the completed application to Charlotte McShan, 6586 FM 1130, Orange, TX 77632 and 409-883-2232 ext. 2390. If you have questions about applying for free or reduced-price meals, contact her at cmcshan@lcmcisd.org  or call Suzanne Magee at 409-883-2232 ext. 2440.
  2. Who Can Get Free Meals?
  • Income—Children can get free or reduced-price meals if a household’s gross income is within the limits described in the Federal Income Eligibility Guidelines.
  • Special Assistance Program Participants—Children in households receiving benefits from the Supplemental Nutrition Assistance Program (SNAP), Food Distribution Program for Households on Indian Reservations (FDPIR), or Temporary Assistance for Needy Families (TANF), are eligible for free meals.
  • Foster—Foster children who are under the legal responsibility of a foster care agency or court are eligible for free meals.
  • Head Start, Early Head Start, and Even Start—Children participating in these programs are eligible for free meals.
  • Homeless, Runaway, and Migrant—Children who meet the definition of homeless, runaway, or migrant qualify for free meals. If you haven’t been told about a child’s status as homeless, runaway, or migrant or you feel a child may qualify for one of these programs, please call or email Jody Slaughter at 409-883-2232 ext. 2730 jslaughter@lcmcisd.org.
  • WIC Recipient—Children in households participating in WIC may be eligible for free or reduced-price meals.
  1. What If I Disagree With the School’s Decision About My Application? Talk to school officials. You also may ask for a hearing by calling or writing to Dr. Pauline Hargrove at 409-883-2232 6586 FM 1130 Orange, TX 77632.
  2. My Child’s Application Was Approved Last Year. Do I Need To Fill Out A New One? Yes. An application is only good for that school year and for the first few days of this school year. Send in a new application unless the school has told you that your child is eligible for the new school year.
  3. If I Don’t Qualify Now, May I Apply Later? Yes. Apply at any time during the school year. A child with a parent or guardian who becomes unemployed may become eligible for free and reduced-price meals if the household income drops below the income limit.
  4. What If My Income Is Not Always the Same? List the amount normally received. If a household member lost a job or had hours/wages reduced, use current income.
  5. We Are in The Military. Do We Report Our Income Differently? Basic pay and cash bonuses must be reported as income. Any cash value allowances for off-base housing, food, or clothing, or Family Subsistence Supplemental Allowance payments count as income. If housing is part of the Military Housing Privatization Initiative, do not include the housing allowance as income. Any additional combat pay resulting from deployment is excluded from income.
  6. May I Apply If Someone in My Household Is Not a U.S. Citizen? Yes. You, your children, or other household members do not have to be U.S. citizens to apply for free or reduced-price meals.
  7. Will Application Information Be Checked? Yes. We may also ask you to send written proof of the reported household income.
  8. My Family Needs More Help. Are There Other Programs We Might Apply For? To find out how to apply for other assistance benefits, contact your local assistance office or 2-1-1.
  9. Can I Apply Online? No, the online application is not available at this time.

If you have other questions or need help, call Suzanne Magee at 409-883-2232 ext. 2440. Si necesita ayuda, por favor llame al teléfono: Suzanne Magee at 409-883-2232 ext. 2440.

Sincerely,

Suzanne Magee

Directions for Applying For Free and Reduced-Price School Meals

Please use these instructions to complete the free or reduced-price school meals application. Submit one application per household, even if the children in the household attend more than one school in Little Cypress Mauriceville CISD. Please use a pen (not a pencil) when completing the application. The application must be filled out completely in order for the school to make a determination if the children in your household qualify for free or reduced-price school meals. An incomplete application cannot be approved. Please contact Suzanne Magee at 409-883-2232 or email her at smagee@lcmcisd.org  with your questions.

Step 1: List All Household Members Who Are Infants, Children, And Students Up to and Including Grade 12.

  • List each child’s name.

Print first name, middle initial, and last name for each child in the household in the spaces. If there are more children than lines, use the back of the application to record additional names.

Include all household members who are age 18 or under and are supported with the household’s income including children who are not enrolled in the district. Children do NOT have to be related to anyone in the household to be a part of the household.

  • Mark the box following the child’s name to show if the child is a student in the Little Cypress Mauriceville CISD.
  • Record the child’s grade if the child is in school.
  • Check the appropriate box if a child qualifies for free meals as participant in the foster care system, Head Start (including Early Head Start or Even Start) program or if a child meets the criteria for homeless, migrant, or runaway.

Checking Foster indicates that a foster care agency or court has placed the child in your home. If the application is being submitted for foster children only, complete Step 1, skip Step 2, and complete Step 3.

Participation in a Categorical Program

If all children in the household are participants in one of the following programs—Foster, Head Start, Homeless, Migrant, or Runaway, skip Step 2 and complete Step 3.

SNAP, TANF, and FDPIR: Do any household members (including you) currently participate in one or more of the following assistance programs: SNAP, TANF, or FDPIR?

If a child or adult in the household participates in Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance to Needed Families (TANF), record the Eligibility Determination Group (EDG) number in the space.

If a child or adult in the household is a participant in Food Distribution Program for Households on Indian Reservations (FDPIR), check the box to indicate participation. The Little Cypress Mauriceville CISD will contact you to obtain documentation of FDPIR participation.

If the students in the household are eligible based on SNAP, TANF, or FDPIR, skip Step 2 and complete Step 3.Step 2: Report Income for All Household Members.

Part A. Total Household Members

  • Record the total number of children and adults in the household in the appropriate box.

This number MUST be equal to the number of household members listed in Step 1 and Step 2. It is very important to list all household members as the size of the household determines the household eligibility.

Part B. Last Four Digits of Social Security Number (SSN) of an Adult Household Member

  • Provide the last four digits of the Social Security number (SSN) of an adult in the household or check the box for no SSN.

A social security number is not required to apply for these programs.

Part C. Income for All Adult Household Members (Including Yourself, But Not Children)

  • Record the first and last name of each adult in the household in the space provided.

If there are more adults in the household than available spaces, use the back of the application. Childrens income is reported in Part D.

Include all adults living in the household that share income and expenses, even if the adult is not related to anyone in the household and does not receive any income. Do not include adults that are not supported by the household’s income and do not contribute income to the household.

  • Record the amount of income the adult receives under the type of income: Working Earnings; Public Assistance/Child Support/Alimony; Pensions/ Retirement/Social Security/ Supplemental Security Income (SSI); and All Other.

Report all amounts in gross income only and in whole dollars. Gross income is the total income received before taxes or deductions. Ensure that the income reported has not been reduced by the amounts deducted for taxes, insurance premiums, or any other purpose. The Adult Income Information Box provides additional information on the types of income that need to be reported. Foster children may be included as a member of the household or may be included on a separate application.

Write a 0 in any field where there is no income to report. 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 the household income was reported incorrectly, the application will be verified for cause.

  • Circle how often each type of income is received (frequency).
  • W = Weekly
  • E = Every 2 Weeks
  • T = Twice per Month
  • M = Monthly
  • A = Annually

Part D. Combined Income for Children in the Household

  • Record total income for all children by how often income is received (frequency).

Record adult income in Part C.

It is not necessary to record the income of children individually. Instead, combine and report children’s total income by frequency. For example, combine all income received weekly and record the total amount in the space under weekly.

The Child Income Information Box (on the right) provides additional information on the types of income that needs to be reported for children in the household.

Step 3: Provide Contact Information and Adult Signature.

  • Read the certification statement.
  • Write your current address and contact information in the space provided. Sharing a phone number, email address, or both is optional, but helps us reach you quickly if we need to contact you.

If you have no permanent address, this does not make your children ineligible for free or reduced-price school meals.

  • Print the name of the adult signing the form, sign the form, and record today’s date in the appropriate spaces.

All applications must be signed by an adult household member. By signing the application, the household member is promising that all information has been truthfully and completely reported. Before completing this section, please read the privacy and civil rights statements on the back of the application.

 

Reduced-Price Meal Income Eligibility Guidelines

Family Size

Annually

Monthly

Twice per Month

Every Two Weeks

Weekly

1

$21,978

$1,832

$916

$846

$423

2

$29,637

$2,470

$1,235

$1,140

$570

3

$37,296

$3,108

$1,554

$1,435

$718

4

$44,955

$3,747

$1,874

$1,730

$865

5

$52,614

$4,385

$2,193

$2,024

$1,012

6

$60,273

$5,023

$2,512

$2,319

$1,160

7

$67,951

$5,663

$2,832

$2,614

$1,307

8

$75,647

$6,304

$3,152

$2,910

$1,455

For each additional family member add:

+ $7,696

+ $642

+ $321

+ $296

+ $148

Little Cypress Mauriceville CISD, 2016-2017 Multi-Child Application for Free and Reduced-Price School Meals

Complete one application per household. Please use a pen (not a pencil).

This Box for School Use Only.

Date Withdrawn:

Step 1

Definition of Household Member: Anyone who is living with you and shares income and expenses, even if not related.

Children in Foster care; children who meet the definition of Homeless, Migrant, or Runaway or who participate in Head Start are eligible for free meals.

Please read the directions for more information.

List ALL Household Members Who Are Infants, Children, and Students up to and Including Grade 12. If more spaces are needed, use the Additional Household Member Sheet on the back.

List each child’s name.

Student Attends School in District?

Grade

Optional: Student ID Number

Check all that apply.

First Name

MI

Last Name

Yes          No

Foster

Head Start

Homeless

Migrant

Runaway

1.

         

2.

         

3.

         

4.

         

5.

         

6.

         

Participation in a Categorical Program

  • If every child listed in Step 1 is a participant any one of the following programs—Foster, Head Start, Homeless, Migrant, or Runaway, skip Step 2 and complete Step 3.
  • SNAP, TANF, or FDPIR: Do any Household Members (including you) currently participate in SNAP, TANF, and/or FDPIR?

If No, complete Steps 2 and 3. If Yes to SNAP/TANF > Write the Eligibility Determination Group (EDG) number in this space ____________________, skip Step 2, and complete Step 3.

If Yes to FDPIR, check this box , skip Step 2, and complete Step 3.

Step 2

Please read the directions for more information.

Report Income for ALL Household Members (Skip this step if you entered an EDG number or checked the box to indicate participation in FDPIR in Step 1).

  1. Total Household Members (Children & Adults)

_____

  1. Last Four Digits of Social Security Number (SSN) of an Adult Household Member:

X X X XX

__

__

__

__

Check if no SSN

  1. Income for Adult Household Members (Including Yourself, But Not Children)

List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total income (without deductions) for each source in whole dollars only. Indicate the frequency of income: W=Weekly, E=Every 2 Weeks, T=Twice per Month, M=Monthly, A=Annually. If they do not receive income from any source, write ‘0.’ If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report.

Adult’s First/Last Name

Work Earnings

(Enter Amount)

Frequency

(Circle One)

Public Assistance/ Child Support/Alimony

(Enter Amount)

Frequency

(Circle One)

Pensions/Retirement/ Social Security/Supplemental Security Income

(Enter Amount)

Frequency

(Circle One)

All Other

(Enter Amount)

Frequency

(Circle One)

1.

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

2.

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

3.

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

4.

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

5.

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

$

W–E–T–M–A

  1. Combined Income for Children in the Household

Weekly

Every 2 Weeks

Twice per Month

Monthly

Annually

Record combined total income by frequency for all children listed in Step 1.

$

$

$

$

$

Step 3

Please read the directions for more information.

Provide Contact Information and Adult Signature.

I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.

Street Address/Apt #

City

State

Zip

Daytime Phone and Email (Optional)

Printed Name of Adult Completing the Form

Signature of Adult Completing the Form

Today’s Date