Ellsworth

Ellsworth Public SchoolNewsletter

August / September 2019

All students who will be attending Ellsworth Public School for the 2019-2020 school year, need to Register at the school: Tuesday, August 20 12:00 PM--7:00 PM OR Wednesday, August 21

9:00 AM--3:00 PM We have planned two registration days to accommodate everyone.Please come to register for classes.

School RegistrationThis issue of the newsletter includes the supply list, fee list, activity schedule for the 2019-2020 school calendar year.Please come to register for classes, purchase lunch and activity tickets. Physical forms need to be turned into the office. Signed medication forms and permission forms will also need to be completed. Please bring two check blanks.The milk and lunch payments need to be separate from the other fees. It is very helpful if all parents and guardians bring phone, cell phone numbers and email addresses to registration. Lunch application forms are also enclosed in this issue. Please call the school office if you need assistance with these forms. It is helpful if you return these applications when you register. Kindergarten parents need to bring any immunization records, copies of birth certificates and any other information with you at the time of registration.

The entire staff at Ellsworth Public School looks forward to another productive year.

WOW, Where Did Summer Go?

The beginning of school is just around the corner with the first day of school for students being September 3rd. At this time we have also hired a few new teachers, a new Family and Consumer Ed Teacher, a new K-12 Music Teacher, a new 7-12 AG Teacher and a new K-6 Title One Teacher along with a new evening custodian and some new substitutes. We look forward to welcoming these new individuals into the Ellsworth family.

Some extracurricular events will be starting up before school starts this year. Please check out the school calendar or watch for mailings or website updates on start dates and practice times for football, volleyball and cross-country.

Financially, Ellsworth School is making some very tough decisions in the coming months. For the past few years the cost to operate schools around the state of Minnesota has increased drastically and state funding to Minnesota schools is not keeping up., to the point that the last few years Ellsworth School has been running a deficit in their spending and covering that deficit by using our fund balance. What does this mean for the school and the residents in the Ellsworth District? It means we need to find more sources for revenue. There are basically two sources for additional revenue: increase student numbers or ask voters for additional funding through an operating referendum. Ellsworth student numbers have decreased over the past 10 years but are stabilizing somewhat these past 2 years at or around 140 total students. We would like to see around 160 total students each year which would help our revenue stream by about $100,000 or more. Finding that many more students is an extremely tough task. So during the upcoming School Board meeting in August the Ellsworth School Board will be voting on asking the Ellsworth residents to increase their tax dollars support. There is a large amount of information and details that goes into this request. If the School Board votes to move forward with an operating referendum we will begin to hold a number of information sessions where your questions can be asked and answered. So please watch our school website, facebook site, mailings, or school notice board for upcoming dates and information. We want our Ellsworth residents to be completely informed and educated on what this means to our community and school.

Again, remember school starts September 3rd for all students and we look forward to seeing all the students and staff in the building again soon and we hope everyone had a great summer!

John R. WilleySuperintendent/Principal

First Day Of Volleyball Practice (7th - 12th)Monday, August 12th - 4:15 - 7:15 pm

First Day Of Football Practice (9th - 12th)Monday, August 12th

8:00 - 10:00 am AND 6:00 - 8:00 pm

First Day Of Jr. High Football Practice (6th-8th)

Monday, August 12th - 8:00 - 10:00 am

First Day Of Cross Country PracticeMonday, August 12th - 9:00 am

School Registration:August 20th 12:00 - 7:00 pm

August 21st 9:00 am - 3:00 pm

EPTO MeetingAugust 20th - 6:30 pm

Volleyball GameAugust 27th @ Home

Open HouseElementary Pre K - 4th

August 28th - 4:00-8:00 pm

Football GameAugust 29th @ RTR

First Day Of SchoolSeptember 3rd

* Dates To Remember * We would like to thank everyone for supporting the Summer Food Service Program. We had a wonderful response to the program and appreciate everyone’s support! We hope to continue this program again next summer.

Please mark your calendars for an event you won't want

to miss!

Wednesday, Sept 4th 7:00 pm at

Zion Presbyterian Church -----------------------------------------

Zion Presbyterian Women will present faith leader and

speaker:

TIM WEIDENBACH(from Parkston SD.)

One of the topics Tim will be speaking on is

"distracted driving". This event will be open to

the public and we invite all area churches and youth to this event. More details will

be coming soon.

Adrian AreaFootball 2019

DRAGON COMBINE: The dragon Combine is a test of individual endurance, speed, strength, and talent that takes place during the first week of football practice. There will be two running events: the shuttle and the 40 yard dash, two weight events: bench reps & leg reps, two special events: kicking & punting, Seniors and Juniors will compete against one another, Sophomore/Freshmen, and Eighth/Seventh/Sixth. Each individual will have a chance to earn a certificate if they score the highest points in a category.CONDITIONING: Knowing the we will start our season with individual competition you will want to begin preparing for the running, lifting, etc. Running, both distance and sprints, are a must for total conditioning. Also include flexibility, strength, quickness, and agility. Your conditioning program will eliminate sores, aches, and pains. It will also make it somewhat easier to endure the first days of practice. It is important that you begin conditioning ASAP!SPECIALIST: You can only improve yourself by getting out and practicing these things If you need equipment, it may be picked up from a coach during the evening hours. Punters-punt,Kickers-kick, Snappers-snap, …………SEASON STARTS: Officially the start of the football season is Monday, August 12, 2019. On the 12th be dressed and READY to have at it at 8:00 am...SHARP!!!PRACTICES: VARSITY (9-12): We will start our two-a-day practices on Monday. August 12. The morning practices will run from 8:00am to 10:00am with the evening practice running from 6:00pm to 8:00pm. JUNIOR HIGH (grade 6-8): On Monday, August 12 through Thursday, August 15, practices will be at 8:00am to 10:00 am. NOTE: no junior high practices on Fridays.PAPERWORK: Most of your paperwork can be completed the night of the (Parent-Player Eligibility Meeting. Adrian athletes turn their paperwork/payment into the Adrian office, while Ellsworth athletes turn their paperwork into the Ellsworth office. The paperwork (eligibility-parent permit-MSHSL-health questionnaire) form need to be completed and turned in ASAP.PHYSICALS: Individuals that need to have a physical (every three years-Freshmen/Sophomores/Seniors and Sixth Graders) should have them completed by August 12th. If you aren’t sure you need to, check with the school nurse or high school office.ACTIVITY FEES: Each player is required to pay a sports activity fee. A portion of this fee will go towards the football awards. This fee should be paid in the District Office and should be paid by the beginning of the second week (Adrian athletes pay Adrian, Ellsworth athletes pay Ellsworth).

General Football Information

You’RE Invited!Ellsworth ElementaryOpen House

The Pre-K through 4th Grade will be holding an Elementary Open House on Wednesday, August 28th from 4:00-8:00pm. During this time, the Pre-K - 4th Grade teachers will be in their rooms for you and your child to stop by and get a chance to meet their teacher, view their room, and drop off their school supplies. There also will be root beer floats, popcorn and a bounce house at the East Entrance of the School!

● WHEN: Wednesday, August28th from 4:00-8:00pm

● Where: East Entrance of theEllsworth School.

● Who: Parents & Students

● Hosted By: EPTO

New Staff will be available between 5:30 - 6:30!

● Ag Instructor: Bailey Rempel

● FACS: Katie Klosterbuer

● Band/Music: Jaysa Saumer

SET UP CONCESSIONS

8/27/19 Edgerton Board Rondae N

Danielle V

9/9/19 Dell Rapids Kallie C Micah O

Kendra D Linkin B

9/12/19 SWC Kaitlyn C Emily L

Cecelia L Robby A

10/1/19 H-BC Kassidy N Simon B

Katie B Cole B

10/3/19 W-WG Claire P Peyton L

Brynn B Elijah K

10/10/19 MLAC Morgan D Logan B

Ashlyn M Josh J

1 2 3

4 5 6 7 8 9 10

11 12VB Practice startsFB Practice startsJH FB Practice startsCC Practice starts

13 14 15 16 17

18 19

School Board MTG. 6:30pm

20School Registration12 - 7 PM

EPTO Mtg.6:30pm

21School Registration9 AM - 3 PM

22 23 24FB V/JVScrimmage@ Luverne10:00am

25 26Teacher Workshop

27Teacher Workshop

VB Edg. (H)

(B)-FB Luv. (H)

28Teacher Workshop

Open HousePre K-4th 4:00-8:00pm

29Teacher Workshop

FB RTR (A)

30 31

VB AdrianTournament

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

August 2019Calendar

Ellsworth Public School2019-2020 Calendar

July 2019 January 2020S M T W T F S S M T W T F S

1 2 3 4 Jan 1 NO SCHOOL

1 2 2 4 5 6 5 6 7 8 9 10 11 Jan.2 – School Resumes

7 8 9 10 11 12 13 12 13 14 15 16 17 18 17 – Early Release

14 15 16 17 18 19 20 19 20 21 22 23 24 25 17 – End of Quarter 2 – 45 Days

21 22 23 24 25 26 27 26 27 28 29 30 31 Jan 20 Teacher In-Service

28 29 30 3121

August 2019 February 2020S M T W T F S S M T W T F S

11 2 3 2 3 4 5 6 7 8

4 5 6 7 8 9 10 28st 4:00 – 8:00 Pre K - 4 9 10 11 12 13 14 15 14 – Early Release

11 12 13 14 15 16 17 Open House 16 17 18 19 20 21 22 20 - PT Conf 4:00 to 8:00

18 19 20 21 22 23 24 26-29 Teacher In-Service 23 24 25 26 27 28 29

25 26 27 28 29 30 31 27 - Bus & Health & Safety4 20

September 2019 March 2020S M T W T F S S M T W T F S

1 2 3 4 5 6 7 2 - Labor Day NO SCHOOL 1 2 3 4 5 6 7

8 9 10 11 12 13 14 3 – First Day of School 8 9 10 11 12 13 14 18 – Early Release

15 16 17 18 19 20 21 15 16 17 18 19 20 21 20 – End of Quarter 3 – 43 Days

22 23 24 25 26 27 28 22 23 24 25 26 27 2829 30 30 – PT Conf 4:00 to

8:00 5 - 12 29 30 3120 22

October 2019 April 2020S M T W T F S S M T W T F S

1 2 3 4 5 1 2 3 46 7 8 9 10 11 12 5 6 7 8 9 10 11 9 – Early Release

13 14 15 16 17 18 19 16 – Early Release 12 13 14 15 16 17 18 10 – 13 No School Easter Break

20 21 22 23 24 25 26 17 – 18 Ed MN NO SCHOOL 19 20 21 22 23 24 25

27 28 29 30 31 26 27 28 29 3021 20

November 2019 May 2020S M T W T F S S M T W T F S

1 2 1 – End of Quarter 1 - 42 Days 1 2

3 4 5 6 7 8 9 12 – Pre K – 4 PT 4:00 – 8:00 3 4 5 6 7 8 9 22 – End of Quarter 4 –

43 Days

10 11 12 13 14 15 16 27 – Early Release 10 11 12 13 14 15 16 22 – LAST DAY OF SCHOOL

17 18 19 20 21 22 23 28 – 29 Thanksgiving 17 18 19 20 21 22 23 26 Staff Development24 25 26 27 28 29 30 NO SCHOOL 24 25 26 27 28 29 30 29 - Graduation

3119 16

December 2019 June 2020S M T W T F S S M T W T F S

1 2 3 4 5 6 7 2 - PT Conf 4:00 to 8:00 5 - 12 1 2 3 4 5 6

8 9 10 11 12 13 14 7 8 9 10 11 12 1315 16 17 18 19 20 21 20 - Early Release 14 15 16 17 18 19 2022 23 24 25 26 27 28 Dec 23 through Jan. 1 21 22 23 24 25 26 2729 30 31 NO

SCHOOL 28 29 3015

Snow Make Up Days are, May 26, May 27, May 28, May 29 and Apr 13. Early Release days for Staff Development – Oct 16, Nov 20, Dec 20, Jan 17, Feb 14, Mar 18, & Apr 9.

Ellsworth Public School

2019-2020 School Supply

List Preschool SuppliesPencil box (plastic)2 pencils4 purple glue sticks2 boxes of Crayola crayons (24)10 ct. Crayola broad tip markersScissors1 box of Kleenex1 Blue folder (Monday, Wednesday, Friday class)1 Red folder (Tuesday, Thursday class) Kindergarten SuppliesAny health, immunization or registration forms that have not been turned inBackpackPlastic rest matStandard size plastic pencil boxKid-sized headphones/earbuds1 box of Crayola crayons (8)2 boxes of Crayola crayons (24)#2 Pencils10-12 Glue Sticks1 (4 oz) bottle Elmer’s glue4-5 Expo Dry Erase Markers1 Small Scissors1 Pink Eraser2 Plastic Folders2 Boxes of Kleenex Velcro Gym ShoesBoys – Plastic spoons & forksGirls – Gallon Size Ziploc BagsExtra set of clothes to keep in lockerDue to Allergies: Money for the school to purchase a shared snack.Please label everything

First Grade Supplies10-12 pencils--#2 lead2 Large Pink Erasers1 box of Crayola crayons (24)2 Small bottles of Elmer’s glue5 Fine tip expo dry erase markers2 LARGE boxes of KleenexScissorsGirls – 1 box of Gallon Ziploc bagsBoys – 1 box of Ziploc Sandwich bags2 Jumbo Glue SticksStandard Size Pencil box1 set of earbuds (for iPad work)Gym shoes (Velcro) Second Grade Supplies12 pencils--#2 lead1 box of 24 crayonsCrayola colored pencils (24)Small bottle of glue8 Elmer’s Glue sticksScissors2 big erasers1 Highlighter1 wide-ruled notebook4 expo dry erase markers1 set of earbudsStandard Size Pencil boxGym shoes1 LARGE box of Kleenex2 Red pensLast Name A-I – box of gallon Ziploc bagsLast Name J-Z – box of quart Ziploc bags

Third Grade SuppliesStandard Size plastic pencil boxKid-sized headphones/earbuds12 pencils--#2 lead2 big erasers2 ink pens – No Red2 Highlighters1 box of Crayola markers1 box of 24 Crayola colored pencils1 Scissors4 Expo dry erase markers8 glue sticks1 Ruler7 pocket folders – all different colors5 notebooks (wide) all different colorsPaint brush small pack1 paint shirt

Third Grade Cont.Gym Shoes3 LARGE boxes of KleenexLast Name A-I – box of gallon Ziploc bagsLast Name J-Z – box of quart Ziploc bags

Fourth Grade Supplies4 Pencils--#2 lead(NO mechanical pencils)2 Ink pens1 Yellow highlighter5 Notebooks (wide lined)7 Folders1 Eraser1 ScissorsPencil BoxCrayonsMarkers1 Ruler with metric1 Glue stick or small bottle of glue3 Large boxes of Kleenex1 Paint ShirtGym Shoes

Fifth Grade Supplies#2 Pencils (15-20)6 Folders5 Notebooks (wide-lined)1 Scissors1 Ruler1 Highlighter1 Big EraserBox of colored pencilsBox of markersPencil Box3 LARGE boxes of KleenexGym shoes

Sixth Grade Supplies#2 pencils (15-20)6 Folders5 Notebooks (wide-lined)1 Scissors1 Ruler1 Highlighter1 Big EraserBox of colored pencilsBox of markersPencil Box3 Large boxes of KleenexGym shoes

School starts onSeptember 3, 2019

2019-2020 FEES

Food Service Prices Adult K-6 7-12Lunch Daily $ 3.75 $ 2.75 $ 2.85Reduced Lunch Daily $ .00 $ .00Breakfast $ 2.40 $ 1.65 $ 1.65Milk per carton $ .35 $ .35 $ .35Milk per semester $ 32.00 Milk per year $ 64.00

Activity Tickets All SeasonFamily $80.00Adult-Single $35.00Student $20.00Seniors (62+) $25.00

Admission Prices Adults Students Sport Events $6.00 $4.00 Play $6.00 $4.00

Activity Fee 7-8 9-12

Per Sport $40.00 $40.00 Family cap of $100

Insurance

NOT AVAILABLE THIS YEAR

Class Dues:Grades 7-8 $1.00Grade 9 $2.00Grade 10 $3.00Grade 11 $4.00Grade 12 $5.00

Driver Ed. Fee $300.00

2NO SCHOOLLABOR DAY

3Waffle Sticks w/ SyrupSausage LinkFruitJuiceMilk

4Breakfast PizzaFruitJuiceMilk

5Glazed DonutYogurtJuiceMilk

6Cereal Toast w/ JellyFruitJuiceMilk

9CerealToast w/ JellyFruitJuiceMilk

10Pancake on a Stick w/ SyrupFruitJuiceMilk

11Ham, Egg and Cheese on a BiscuitFruitJuiceMilk

12Coffee CakeYogurtJuiceMilk

13CerealToast w/ JellyFruitJuiceMilk

16CerealToast w/ JellyFruitJuiceMilk

17French Toast Stick W/SyrupFruitJuiceMilk

18Egg BakeFruitJuiceMilk

19Cinnamon RollsYogurtFruitJuiceMilks

20CerealToast w/ JellyFruitJuiceMilk

23CerealToast w/ JellyFruitJuiceMilk

24Pancakes W/ SyrupSausage LinkFruitJuiceMilk

25OmeletToastFruitJuiceMilk

26Pop TartsYogurtJuiceMilk

27CerealToast w/ JellyFruitJuiceMilk

30CerealToast w/ JellyFruitJuiceMilk

THIS INSTITUTION IS AN EQUAL OPPORTUNITY PROVIDER

ALL ITEMS ARE WHOLE GRAIN RICH.

SEPTEMBER 2019BREAKFAST

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

2LABOR DAY

NO SCHOOL

3Corn DogsBreadGreen BeansFruitMilk

4Hamburger on a BunBaked BeansFruitMilk

5Super NachoCornBreadFruitMilk

6Chicken StripsGlazed CarrotBreadFruitMilk

9Scalloped Potatoes w/ HamPeasBreadFruitMilk

10Chicken AlfredoGarlic BreadstickDk Green LettuceFruitMilk

11Pizza CornFruitMilk

12Shrimp PoppersCheese StickGlazed CarrotsBreadFruitMilk

13BBQ on a BunBaked BeansFruitMilk

16Tater Tot HotdishGreen BeansBreadFruitMilk

17Hot Pork on a BunCarrotsFruitMilk

18Chicken Fried SteakBaked BeansBreadFruitMilk

19Baked Potato w/ ToppingsBreadFruitMilk

20Chicken Patty on BunBroccoliFruitMilk

23Pizza BoatsCornFruitMilk

24Spaghetti w/ Meat SauceGarlic BreadstickGreen BeansFruitMilk

25Hot Dog on a BunSweet Potato TotsFruitMilk

26Fish NuggetsBaked BeansBreadFruitMilk

27Taco HaystackBreadFruitMilk

30Chicken FajitaDk Green LettuceFruitMilk

THIS INSTITUTION IS AN EQUAL OPPORTUNITY PROVIDER

ALL BREADS AND PASTAS ARE WHOLE GRAIN RICH

SEPTEMBER 2019LUNCH

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

Indoor Air Quality Parent Notification

July 2019 Dear Parent or Guardian: Re: Indoor Air Quality (Ellsworth Public School) I.S.D. #514 now has in place a program to monitor and improve indoor air quality at our school. The Ellsworth School District considers no objective more important than providing its employees, students, and visitors a healthy, safe environment. Because we believe that indoor air quality is essential to this objective we are sending this notification to inform parents, students and staff of our program to monitor and improve indoor air quality. As part of the program implementation, an Indoor Air Quality Coordinator has been appointed. An annual walk-through will be performed by the Coordinator to evaluate school facilities for obvious water intrusion, ventilation failures, structural problems, overall cleanliness, and the status of the O & M program. In that we have adopted the EPA’s Tools for Schools, the guidelines contained therein will be used to evaluate all classrooms, ventilation systems, and building maintenance issues. The District’s response to parental concerns will be timely and direct. Parent’s questions are always welcome. If a concern would arise we ask the parent to contact John Willey, Indoor Air Quality Coordinator. The Coordinator will be able to assist in evaluating the child’s home or other out of school situation. Additional information is available to parents about school facility construction; maintenance, housekeeping practices, chemicals used, mold and HVAC related information, and other activities that may contribute to a child’s symptoms. ISD #514 accepts the responsibility of monitoring indoor air quality and will/has conducted a survey of the mechanical ventilation rate of each occupied space in the District. Ellsworth Public School is proud to be taking a leadership role in providing a safe, comfortable, and productive environment for our students and staff so that we achieve our core mission-educating students. Our school will continue to follow EPA guidance to improve our indoor air quality by preventing as many problems as possible. If you would have any questions or concerns about this or any other health and safety program please contact us at 507-967-2242. Sincerely, John Willey

Annual Asbestos Notification

2019-2020 School Year

As a result of recent federal legislation (Asbestos Hazard Emergency Response Act – AHERA), each primary and secondary school in the nation is required to complete a stringent new inspection for asbestos and to develop a plan of management for all asbestos-containing building materials. ISD #514 has a goal to be in full compliance with this law and is following the spirit, as well as, the letter of the law. As a matter of policy, ISD #514 shall continue to maintain a safe and healthy environment for our community’s youth and employees. In keeping with this legislation, all buildings (including portables and support buildings) owned or leased by the school district were inspected by EPA accredited inspectors and an independent laboratory analyzed samples. Based on the inspection, the district prepared and the state approved a comprehensive management plan for handling the asbestos located within its buildings safely and responsibly. Furthermore, ISD #514 has completed its AHERA 3-year re-inspection requirements every three years. The districts buildings, where asbestos-containing materials were found, are under repair, removal and Operations and Maintenance. This past year, ISD #514 conducted the following with respect to its asbestos containing building materials: Federal law requires a periodic walk-through (called “surveillance”) every six months of each area containing asbestos. Also the law requires for all buildings to be re-inspected every three years after a management plan is in effect. This will be accomplished under contract by Advanced Health, Safety and Security. Short-term workers (outside contractors) must be provided information regarding the location of asbestos in which they may come into contact. All short-term workers shall contact the lead maintenance person before commencing work to be given this information. ISD #514 has a list of the location(s), type(s) of asbestos-containing materials found in that school building and a description and timetable for their proper management. A copy of the Asbestos Management Plan is available for review in the school office. Copies are available at 25 cents per page. Questions related to the plan should be directed to the district office, which will establish contact with our Account Manager under contract with Advanced Health, Safety and Security. To reach Advanced Health, Safety and Security to discuss the management of our asbestos materials or with any questions, call 605-430-8842.

1 2

LABOR DAY!

3First Day Of School

VB H-BC (A)

JV-FB RTR (H) 5:00

4 5JH-FB MCC(A) 4:30

6

FB MCC (H)

7

CC Luverne 9:30

8 9VB Dell-Rapids-St. Mary’s (H)

JV-FB MCC (A) 5:00

10JH-VB Edg.(H) 4:00

CC @ S-O 4:00

11 12VB SWC (H)

JH-FBWorthington (H) 4:30

13

FB Sleepy - Eye (A)

14

15 16School Board MTG. 6:30 pmCC Windom 4:30JH VB H-BC (H)JV-FB (H) Sleepy-Eye VB S-O Invite

17VB Adrian (A)

JH-FB Pipestone (H) 4:30

18 19

VB Forest-Ridge (A)

20

FB T-M-B (H)

21

22 23

JH-FB TMBat Tracy 5:00

24VB MCC (A)

JH-FB JCC (A) 4:30

25 26VB Edg (A)

JH-FBHLOF (H) 4:30

27 28JH VB H-BC Tour.

FB Wabasso(A) 3:00

29 30ConferencesGrades 5-124:00-8:00pm

JH-FB Wabasso(H) 5:00

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

September 2019Calendar

ELLSWORTH PUBLIC SCHOOL513 S. Broadway St. P.O. Box 8

Ellsworth, MN 56129

Dear Parent/Guardian:

Our school provides healthy meals each day. Breakfast costs $1.65; lunch costs $2.75/2.85.

Your children may qualify for free or reduced-price school meals. To apply, complete the enclosed Application for Educational Benefits following the instructions. A new application must be submitted each year. At public schools, your application also helps the school qualify for education funds and discounts.

State funds help to pay for reduced-price school meals, so all students who are approved for either free or reduced-price school meals will receive school meals at no charge. State funds also help to pay for breakfasts for kindergarten students, so all participating kindergarten students receive breakfasts at no charge.

Return your completed Application for Educational Benefits to:Ellsworth Public School, 513 S. Broadway St., Ellsworth, MN 56129Who can get free school meals? Children in households participating in the Supplemental Nutrition Assistance Program (SNAP), Minnesota Family Investment Program (MFIP) or Food Distribution Program on Indian Reservations (FDPIR), and foster, homeless, migrant and runaway children can get free school meals without reporting household income. Alternatively, children can get free school meals if their household income is within the maximum income shown for their household size on the instructions.

To apply for free school meals, please complete the Application for Educational Benefits form.

COMMON QUESTIONS:

I get WIC or Medical Assistance. Can my children get free school meals? Children in households participating in WIC or Medical Assistance do not automatically qualify for free meals. Children may be eligible for free or reduced-price school meals depending on other household financial information. Please fill out an application.

Who should I include as household members? Include yourself and all other people living in the household, related or not (such as grandparents, other relatives, or friends).

May I apply if someone in my household is not a U.S. citizen? Yes. You or your children do not have to be U.S. citizens for your children to qualify for free or reduced-price school meals.

What if my income is not always the same? List the amount that you normally get. If you normally get overtime, include it, but not if you get overtime only sometimes. For seasonal work, write in the total annual income.

Will the income information or case number I give be checked? It may be. We may also ask you to send written proof.

How will the information be kept? Information you provide on the form, and your child’s approval for meal benefits, will be protected as private data. For more information see the back page of the Application for Educational Benefits.

If I don’t qualify now, may I apply later? Yes. Please complete an application at any time if your income goes down, your household size goes up, or you start getting SNAP, MFIP or FDPIR benefits.

Please provide the information requested about children’s racial identity and ethnicity, which helps to make sure we are fully serving our community. This information is not required for approval of school meal benefits.

If you have other questions or need help, call 507-967-2242.

Sincerely,

Darcey Groen

Household size $ Per Year $ Per Month $ Twice Per Month

$ Per 2 Weeks $ Per Week

1 23,107 1,926 963 889 445

2 31,284 2,607 1,304 1,204 602

3 39,461 3,289 1,645 1,518 759

4 47,638 3,970 1,985 1,833 917

5 55,815 4,652 2,326 2,147 1,074

6 63,992 5,333 2,667 2,462 1,231

7 72,169 6,015 3,008 2,776 1,388

8 80,346 6,696 3,348 3,091 1,546

Add for each additional person

8,177 682 341 315 158

How to Complete the Application for Educational BenefitsComplete the Application for Educational Benefits form for school year 2019-20 if any of the following applies to your household:· Any household member currently participates in the Minnesota Family Investment Program (MFIP), or the Supplemental Nutrition Assistance Program (SNAP), or the Food Distribution Program on Indian Reservations (FDPIR) or· The household includes one or more foster children (a welfare agency or court has legal responsibility for the child) or· The total income of household members is within the guidelines shown below (gross earnings before deductions, not take-home pay). Do not include as income: foster care payments, federal education benefits, MFIP payments, or value of assistance received from SNAP, WIC, or FDPIR. Military: Do not include combat pay or assistance from the Military Privatized Housing Initiative. The income guidelines are effective from July 1, 2019 through June 30, 2020.

Maximum Total Income

Step 1: ChildrenList all infants and children in the household, their school and grade if applicable, and birthdate. Attach an additional page if needed to list all children. Check the box if a child is in foster care (a welfare agency or court has legal responsibility for the child).

Step 2: Case NumberIf any household member currently participates in SNAP, MFIP or FDPIR, write in the case number and then go to Step 4. If you do not participate in any of these programs, leave Step 2 blank and continue on to Step 3.

Step 3: Adult and Child Incomes / Last 4 Digits of Social Security Number

· Child Income. If any children in the household have regular income, such as SSI or part-time jobs, list the total amount of regular incomes received by all children, and check the box for the frequency: weekly, bi-weekly, twice a month, or monthly. Do not include occasional earnings like babysitting or lawn mowing.

· Adult income. Report the names of adult household members and income earned in this section.· List all adults living in the household not listed in Step 1, whether related or not, such as grandparents, relatives, or friends.· Gross Earnings from Work. For each income, check the box to show how often the income is received: weekly, bi-week, twice per month, or monthly.· List gross incomes before deductions, not take-home pay. Do not list an hourly wage rate. For adults with no income to report, enter a ‘0’ or leave the section blank. For seasonal work, write in the total annual income.· Self-employment or Farm Income. List the net income per month or year after business expenses. A loss from farm or self-employment must be listed as 0 income and does not reduce other income.· All Other Gross Income. List gross incomes before deductions from any other sources, such as SSI, unemployment, child support, public assistance, social security, rental income or annuities.· Social Security Number/Total Household Members. An adult household member must provide the last four digits of their Social Security number or check the box if they do not have a Social Security number. The total household members is reported.

Step 4: Signature and Contact Information An adult household member must sign the form. If you do not want your information to be shared with Minnesota Health Care Programs, check the “Don’t share” box in Step 4.

https://www.ellsworth.mntm.org/cms_files/resources/2019-20%20Application%20for%20Educational%20Benefits%20Packet%20SNP%20055492.pdf

2019-20 Application for Educational BenefitsComplete one application per household. Please use pen (not a pencil).

Below you will find the link for the Application for Educational Benefits.Please feel free to print one off and complete and bring with you to the

2019-2020 registration days.

Sources of Child Income Examples Earnings from Work Public Assistance / Alimony/ Child Support

All Other Income

· Earnings from work· Social Security

a. Disability Paymentsb. Survivor’s Benefits

· Income from person outside the household

· Income from any other source

· A child has a regular full or part-time job where they earn a salary or wages

· A child is blind or disabled and receives Social Security

· A Parent is disabled, retired, or deceased, and their child receives Social Security benefits

· A friend or extended family member regularly gives a child spending money

· A child receives regular income from a private pension fund, annuity, or trust

· Salary, wages, cash bonuses (before deductions or taxes)

· Net income from self-employment (farm or business)

· If you are in the U.S. Military:a. Basic pay and

cash bonuses (do NOT include combat pay, FSSA or privatized housing allowances)

b. Allowances for off-base housing, food and clothing

· Cash Assistance from State or local government

· Supplemental Security Income

· Unemployment benefits· Worker’s compensation· Alimony payments· Child support payments· Veteran’s benefits· Strike benefits

· Social Security· Disability

benefits· Regular income

from trusts or estates

· Annuities· Investment

income· Rental income· Regular cash

payments from outside household

INSTRUCTIONS: Sources of IncomeSources of Income for Children Sources of Income for Adults

OPTIONAL: Children’s Racial and Ethnic IdentitiesWe 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.

Ethnicity (check one): ☐ Hispanic or Latino ☐ Not Hispanic or Latino

Race (check one or more): ☐ American Indian or Alaskan Native ☐ Asian ☐ Black or African American ☐ Native Hawaiian or Other Pacific Islander ☐ White

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.

At public school districts, each student’s school meal status also is recorded on a statewide computer system used to report student data to MDE as required by state law. MDE uses this information to: (1) Administer state and federal programs, (2) Calculate compensatory revenue for public schools, and (3) Judge the quality of the state’s educational program.

Nondiscrimination statement: 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, you have two options: 1. Complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at Filing a Program Discrimination Complaint as a USDA Customer, and at any USDA office; or, 2. Write a letter addressed to USDA; 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 one of the following methods:(1) Mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights1400 Independence Avenue, SW

Washington, D.C. 20250-9410;(2) Fax: 202-690-7442; or(3) Email: program.intake@usda.govThis institution is an equal opportunity provider.