National School Lunch Program 

SUBMIT ONE APPLICATION PER HOUSEHOLD
(Note:  A new application must be filed every year)

Related Documents:
Instructions
Application
Material Fee Waiver Form

July, 2008
Dear Parent/Guardian:

The School District of Elmbrook serves meals each school day. Children may buy a lunch for $1.60 at elementary grades K thru 5 and $1.85 for grades 6 - 12. Children also may get meals free or at a reduced price. All meals served must meet standards established by the U. S. Department of Agriculture. However, if a child has been determined by a doctor to have a disability and the disability would prevent the child from eating the regular school meal, this school will make any substitutions prescribed by the doctor. If a substitution is needed, there will be no extra charge for the meal. If you believe your child needs substitutions because of a disability, get in touch with us for further information.

If you now get FoodShare or W-2 cash benefits for your children, your children can get free meals. If your total household income is the same or less than the amounts on the Income Scale below, your children can get free meals or reduced price meals. A foster child may get free or reduced price meals regardless of your income. The reduced price is $.40 per lunch.

TO GET FREE OR REDUCED PRICE MEALS FOR YOUR CHILDREN, YOU MUST COMPLETE AN APPLICATION AND RETURN IT TO THE SCHOOL. WE CANNOT APPROVE AN APPLICATION THAT IS NOT COMPLETE.

HOW TO APPLY

If you now get FoodShare or W-2 cash benefits for the children you are
applying for, the application must have the children's names, a FoodShare or
W-2 cash benefit number for each child, and the signature of an adult
household member, If you are applying for a foster child, the application must
have the child's name, the child's "personal use" income and an adult
signature. If you do not list a FoodShare or W-2 cash benefit number for all
the children you are applying for, then the application must have the children's
names, the names of all household members, the amount of income each
person got last month and where it came from, the signature of a adult
household member and that adult's social security number or the word "none"
if the adult does not have a social security number.
INCOME SCALE
Household Size Annual Monthly Weekly

1 .......................... $19,240 ................... $1,604 .................... $ 370
2 ............................ 25,900 ..................... 2,159 ....................... 499
3 ............................ 32,560 ..................... 2,714 ....................... 627
4 ............................ 39,220 ..................... 3,269 ....................... 755
5 ............................ 45,880 ..................... 3,824 ....................... 883
6 ............................ 52,540 ..................... 4,379 .................... 1,011
7 ............................ 59,200 ..................... 4,934 .................... 1,139
8 ............................ 65,860 ..................... 5,489 .................... 1,267

Verification: Your eligibility may be checked at any time during the school year. School officials may ask you to send papers showing that your children should get free or reduced price meals.

Fair Hearing: You may talk to school officials if you do not agree with the school's decision on your application or the results of verification. You also may ask for a fair hearing. You may do this by calling or writing: Robert C. F. Borch, 13780 Hope Street, P.O. Box 1830, Brookfield, Wisconsin 53008-1830.

Confidentiality: The information provided by the household on the application is confidential. Public Law 103-448 does authorize the release of student free and reduced price school meal eligibility status to persons directly connected with the administration and enforcement of federal or state educational program. With your written consent, they may also use the information for other programs if you sign a statement waiving confidentiality for those specific uses.

Reapplication: You may apply for meals anytime during the school year. If you are not eligible now but have a change like a decrease in household income, an increase in household size, become unemployed or get FoodShare or W-2 cash benefits for your children, complete an application then. If the child you are applying for is believed to be homeless, migrant or runaway, please contact your school, homeless liaison or migrant coordinator.

IN ACCORDANCE WITH THE FEDERAL LAW AND US DEPT. OF AGRICULTURE POLICY, NO CHILD WILL BE DISCRIMINATED AGAINST BECAUSE OF RACE, SEX, COLOR, NATIONAL ORIGIN, AGE OR DISABILITY. IF YOU BELIEVE YOU HAVE BEEN DISCRIMINATED AGAINST, YOU MAY FILE A COMPLAINT TO: USDA, DIRECTOR, OFFICE OF CIVIL RIGHTS, ROOM 326-W, WHITTEN BLDG., 1400 INDEPENDENCE AVENUE SW, WASHINGTON, D.C. 20250-9410 OR CALL 202-720-5964. USDA IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER.

We will let you know when your application is approved or denied.

Sincerely,
School District of Elmbrook
Robert C. F. Borch
Assistant Superintendent for Finance and Operations