Dear Parent/Guardian:

 

Children need healthy meals to learn. The Tyngsborough Public School District offers healthy meals every school day.  At the Tyngsborough Elementary School, the lunch price is $2.80/day.  At the Tyngsborough Middle School and at the Tyngsborough High School, the lunch price is $3.00/day.  Your children may qualify for free meals or for reduced price meals. Reduced price is 40 cents for lunch. This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions and answers to help you with the application process.

 

Frequently Asked Questions

Who can get free or reduced price meals?

·         All children in households receiving benefits from MA SNAP, MA TAFDC, or specific categories of Medicaid are eligible for free meals.

·         Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals.

·         Children participating in their school’s Head Start program are eligible for free meals.

·         Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.

·         Children may receive free or reduced price meals if your household’s income is within the limits on the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart.

FEDERAL ELIGIBILITY INCOME CHART For School Year 2018-2019

Household size

Yearly

Monthly

Weekly

1

$22,459

$22,459

$1,872

 

30,451

2,538

 

38,443

3,204

 

46,435

3,870

 

54,427

4,536

 

62,419

5,202

 

70,411

5,868

 

78,403

6,534

 

+7,992

+666$22,311

$1,872

$432

$432

 

586

 

740

 

893

 

1,047

 

1,201

 

1,355

 

1,508

 

+154430

2

30,451

2,538

586

586

3

38,443

3,204

740

740

4

46,435

3,870

893

893

5

54,427

4,536

1,047

6

62,419

5,202

1,201

7

70,411

5,868

1,355

8

78,403

6,534

1,508

Each additional person:

+7,992

+7,992

+666

+666

+154

 

 

HOW DO I KNOW IF MY CHILDREN QUALIFY AS homeless, MIGRANT, OR RUNAWAY?

Do the members of your household lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and haven’t been told your children will get free meals, please call or e-mail Sarah Lewenczuk, Homeless, Migrant/Runaway Liaison, Tyngsborough Public Schools, 50 Norris Road, Tyngsborough, MA 01879, (978)649-8914, sarah.lewenczuk@tyngsboroughps.org.

Do I need to fill out an application for each child? 

No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to: Caren Chasse, Free & Reduced Lunch Coordinator, Tyngsborough Public Schools, 50 Norris Road, Tyngsborough, MA 01879, (978)649-8914, caren.chasse@tyngsboroughps.org.

SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY APPROVED FOR FREE MEALS? 

No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from your eligibility notification, contact Caren Chasse, Free & Reduced Lunch Coordinator, Tyngsborough Public Schools, 50 Norris Road, Tyngsborough, MA 01879, (978)649-8914, caren.chasse@tyngsboroughps.org immediately.

Can I Apply Online?

No.  At this time, the Tyngsborough Public School District is not set up with online application.

MY CHILD’S APPLICATION WAS APPROVED LAST YEAR.  DO I NEED TO FILL OUT A NEW ONE? 

Yes.  Your child’s application is only good for that school year and for the first few days of this school year.  You must send in a new application unless the school told you that your child is eligible for the new school year. 

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 send in a completed application.

Will the information I give be checked?

Yes. We may also ask you to send written proof of the household income you report.

If I don’t qualify now, may I apply later?

Yes, you may apply at any time during the school year.  For example, children 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.

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 by calling or writing to: Dr. Michael Flanagan, Superintendent of Schools, Tyngsborough Public Schools, 50 Norris Road, Tyngsborough, MA 01879, (978)649-7488, michael.flanagan@tyngsboroughps.org.

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. 

What if my income is not always the same?

List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month.  If you normally get overtime, include it, but do not include it if you only work overtime sometimes.  If you have lost a job or had your hours or wages reduced, use your current income.

WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT?

Household members may not receive some types of income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so.

We are in the military. Do we report our income differently?

Your basic pay and cash bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or clothing, or receive Family Subsistence Supplemental Allowance payments, it must also be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. Any additional combat pay resulting from deployment is also excluded from income.

WHAT IF THERE ISN’T ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? 

List any additional household members on a separate piece of paper, and attach it to your application. Contact Caren Chasse, Free & Reduced Lunch Coordinator, Tyngsborough Public Schools, 50 Norris Road, Tyngsborough, MA 01879, (978)649-8914, caren.chasse@tyngsboroughps.org.to receive a second application.

My family needs more help. Are there other programs we might apply for?

To find out how to apply for MA SNAP or other assistance benefits, contact your local assistance office or call the MA SNAP Hotline at 1-866-950-3663.

If you have other questions or need help, call (978)649-8914.

 

 

Sincerely,

 

 

 

Caren Chasse

Free & Reduced Lunch Coordinator

Tyngsborough Public Schools   

Date:  August 1, 2018

 

 

 

The Richard B. Russell National School Lunch Act requires the information requested in order to verify your children’s eligibility for free or reduced price meals. If you do not provide the information or provide incomplete information, your children may no longer receive free or reduced price meals. Pursuant to Section of 7 of the Privacy Act, disclosure of your Social Security number is not required. We do not need and are not requesting any Social Security numbers that may appear on documents you submit.

 

 

Non-Discrimination Statement: This explains what to do if you believe you have been treated unfairly.

“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.”


stop.png2018-2019 Massachusetts Application for Free and Reduced Price School Meals

If you have received a Notice of Direct CertificationFREE from the school district for free meals, do not complete this application.  If you have received a Notice of Direct CertificationREDUCED PRICE from the school district for reduced price meals, this application may be submitted. DO let the school know if any children in the household are not listed on the Notice of Direct CertificationFREE letter you received.


 


Definition of Household Member: “Anyone who is living with you and shares income and expenses, even if not related.”  Children in Foster care and children who meet the definition of Homeless, Migrant or Runaway are eligible for free meals.  Read How to Apply for Free and Reduced Price School Meals for more information.

Child’s First Name

 

MI

 

Child’s Last Name

 

School Name

Grade

Student?
Circle
Yes or
No

Foster


Homeless

Migrant

Runaway

Check all that apply

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

 

 

 

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

 

 

 

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y   N

o

o

o

o

 

Agency ID Number: _____________________

 


Write the Agency ID Number, then go to STEP 4 (Do not complete STEP 3)                                        Do not provide EBT card number.

 

Review the charts titled “Sources of Income” for more information.  The “Sources of Income for Children” chart will help you with the Child Income section. 

Child Income

How often?

Weekly

Bi-Weekly

2x Month

Monthly

$

 

 

 

 

 

 

¡

¡

¡

¡

The “Sources of Income for Adults” chart will help you with the All Adult Household Members section

 


A. Child Income

Sometimes children in the household earn or receive income. Please include the TOTAL income received by all Household Members listed in STEP 1 here:  

B. All Adult Household Members (including yourself)

Public Assistance/ Child Support/ Alimony

 

Pensions / Retirement / All Other Income

 
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 gross income (before taxes) for each source in whole dollars (no cents) only. 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.

How often?

Weekly

Bi-Weekly

2x Month

Monthly

How often?

Weekly

Bi-Weekly

2x Month

Monthly

How often?

Weekly

Bi-Weekly

2x Month

Monthly

Earnings from Work

 

Name of Adult Household Members (First and Last)

 

 

                                                                          

                                                                          

                                                                          

 

 


Total Household Members (Children and Adults)

XXX-XX-

 


Last Four Digits of Social Security Number (SSN) of

Primary Wage Earner or Other Adult Household Member                                                                                                 Check if no SSN


 


“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 (if available)                                                                    Apt #                                               City                                                                               State                          Zip                                                                                                                       Daytime Phone and Email (optional)

 

Error prone

 
                                                                                                                             

Printed name of adult signing the form                                                                                                       Signature of adult                                                                                                                                                                                Today’s date


 

Sources of Income for Adults

Earnings from Work

Public Assistance / Alimony / Child Support

Pensions / Retirement / All Other Income

-   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

-   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

-   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

 

 

 

 

 
 


We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.

 
Text Box: Sources of Income for Children
Sources of Child Income	Example(s)
- Earnings from work	- A child has a regular full or part-time job where they earn a salary or wages
-	Social Security
-	Disability Payments
-	Survivor’s Benefits	-	A child is blind or disabled and receives Social Security benefits
-	A Parent is disabled, retired, or deceased, and their child receives Social Security benefits
-Income from person outside the household	- A friend or extended family member regularly gives a child spending money
-Income from any other source	- A child receives regular income from a private pension fund, annuity, or trust
Ethnicity (check one):	Race (check one or more):
o  Hispanic or Latino	o  American Indian or Alaskan Native	o  Native Hawaiian or Other Pacific Islander
o  Not Hispanic or Latino	o  Asian	o  White
	o  Black or African American	

 




The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. 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.

 

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, religious creed, disability, age, political beliefs, 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:

mail:    U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410

fax:            (202) 690-7442; or

email:       program.intake@usda.gov.

This institution is an equal opportunity provider.


 


Text Box: Annual Income Conversion: 

Weekly 	x 52
Every 2 Weeks 	x 26
Twice A Month 	x 24
Monthly 	x 12
Total Income                                             Household Size

 

Eligibility:                                                 Categorical Eligibility

Free

Reduced

Denied