WESTBOROUGH PUBLIC SCHOOLS45 West Main Street Westborough, MA 01581 508-836-7700 www.westborou8li.org

Dear Parent/Guardian:

Children need healthy meals to learn. Westhorough Public Schools offers healthy meals every school day. Breakfast costs SI .25 andlunch costs $3.00 at the elementary schools: Breakfast costs SI .25 and lunch costs $3.25 at the middle and high schools. Your childrenmay quali for free meals or for reduced price meals. Reduced price is S0.30 for breakfast and $0.40 for lunch. This packet includesan application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions andanswers to help you with the application process.

Frequently Asked QuestionsWHO CAX GET FREE OR REDUCED PRICE MEALS?

• Alt children in households receiving benefits from MA SNAP, MA TAFDC, FDPIR, or specific categories of Medicaidare eligible for free meats.

• Foster children that arc 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 households 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 belowthe limits on this chart.

FEDERAL ELIGIBILITY INCOME CHART For School Year 2020-2021

Household size Yearly Monthly Weekly

I $23,606 $1,968 $454

2 $31,894 $2,658 $614

3 $40,182 $3,349 $773

4 $48,470 $4,040 $933

5 $56,758 $4,730 $1,092

6 $65,046 $5,421 $1,251

7 $73,334 $6.1t2 $1,411

8 $81,662 $6.802 $1,570

Each additional person: +8,288 +691 +160

HOW DO I KNOW IF MY CHILDREN OUALIFY 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 temporaryhousing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leavetheir prior family or household? If you believe children in your household meet these descriptions and haven’t been told yourchildren will get free meals, please call or e-mail Sherrie Stevens at 508-836-7700 or stevenswestboroughkl2.org.

Do I ,VEED TO FILL OUTAN ,4PPLICAT1ON FOR EACH CHILD?No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve anapplication that is not complete, so be sure to fill out all required information. Return the completed application to your child’sschool immediately.

SHOULD I FILL OUT AN APPLIC4TIO.\ IF JRECEI[‘ED A LE7TER THIS SCHOOL YE4R £4 YLVG 111 CHILDREN AREALREADYAPPRO I ED FOR FREE ME.4 LS?No. but please read the letter you got carefully and follow the instructions. If any children itt your household were missing fromyour eligibility notification, contact your child’s school immediately.

CAN JAPPLY ONLINE?

No, this is not an option at this time.

MY CHILD ‘SAPPLIC4 TION WASAPPROVED LAST YEAR, DO INEED TO FILL OUTA 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 anew 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 rny be eligible for free or reduced price meals. Please send in a completedapplication.

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 unemployedmay 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: Irene Oliver. Director of Finance andAdministration, 45 West Main Street, Westborough, MA 01581. 508-836-7700 or oliveriwestborouuhkl 2.ora

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 S1000 each month, but you missed some work last

month and only made 5900. put down that you made S 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.

WI/AT IF SOME HOUSEHOLD MEMBERS HA J’E 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 becounted 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/F THERE ISN’T ENOUGH SPACE ON THE APPLICATION FOR MYFAMIL 1?List any additional household members on a separate piece of paper and attach it to your application. Contact your child’s school to

receive a second application.

M 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 508-836-7700.

Sincerely,

Irene OliverIrene Oliver

Director of Finance and Administration

August I’ 2020

The Richard S. Russell National School Lunch Act requires the information on this application. You do not have to give

the information, but ifyou do not submit all needed information, 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 primary wage earner or other

adult household member who signs the application. The social security number is not required when you apply on

behalf of a foster child oryou 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 foryour child or when you indicate that the adult household member signing the application does not

have a social security number We will use your informat/on to determine ifyour child is eli’ible for free or reducedprice meals, and for administration and enforcement of the lunch and breakfast programs.

We may share your elig/bility information with education, health, and nutrition programs to help them evaluate, fundor determine benefits for their programs, auditors for program reviews, and law enforcement officials to help themlook into violations ofprogram rules

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 areprohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for priorcivil 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 Serviceat (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 addressedto 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 AgricultureOffice of the Assistant Secretary for Civil Rights1400 Independence Avenue, SWWashington, D.C. 20250-9410;

(2) fax: (202) 690-7442; or

(3) email: programintake@usda.gov.

This institution is an equal opportunity provider.”

I Speak Statements

C .÷c*i1 ;iw lszi UI (Arabic)

C tu Iununui hi hiujhphh (Armenian)

C amt (Chinese Simplified)

C ftt (ChineseTraditional)

C Ja govorim hrvatski. (Croatian)

C -A-S t LLL.o j.ajU Li; t. .Li_I (Farsi)

C Je pane frariçais. (French)

C MiXaw €AAqvIKÔI. (Greek)

C 3YILCtL caq &4 (Gujarati)

C Mwen pale Kreyol. (Haitian Creole)

C 4 Wt tikfl (Hindi)

C Kuv hais lus hmoob. (Hmong)

C */. R* t L i (Japanese)

C arrnriinrnhjw (Khmer)

C -‘!1 “ sJOI[tJ (Korean)

C .&tijajjç,.t.j ji (Kurdish)

C 2!aJt’rc3q w’iwwio. (Lao)

C Vie gorngv Mienh waac. (Mien)

C Mówiç po polsku. (Polish)

C Eu falo Portugis. (Portuguese)

C pw ‘M’t (Punjabi)

C Si roopio no-pyccks. (Russian)

C Ou te tautala faaSamoa. (Samoan)

C Govorim srpski. (Serbian)

C Waxaan ku hadlaa Somali. (Somali)

C Yo hablo espanol. (Spanish)

C ji-J) a,a9MJ3 (Sudanese)

C Marunong po akong magsalita ng Tagalog. (Tagalog)

C 1?IL”W ,viNv (Thai)

C q”icv ,C’Mfl ?S. (Tigrinya)

C q O3MOBJ1RIO ykpaiHcblco.o. (Ukrainian)

C •,-< ,JyUy33js (Urdu)

C Tôi nOi tiéng Vièt. (Vietnamese

USDA is an equal opportunity provider and employer.

Student Name:

________________________________________________

School:

___________________________________________________

Grade:

Forty nine (49) different languages are available at https://wwwfns.usda.ciov/school-meals/trarislated-apolications

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WESTBOROUGH PUBLIC SCHOOLS45 West Main Street• Westborough, MA 01581 508-836-7700 www.westborough.org

Sharing Information with Medicaid/CHIPDear Parent/Guardian:

If your children get free or reduced price school meals, they iiiy also be able to get free or low-cost health insurance

through Medicaid or the State Children’s Health Insurance Program (CHIP). Children with health insurance are more likely

to get regular health care and are less likely to miss school because of sickness.

Because health insurance is so important to children’s well-being, the law allows us to tell Medicaid and CHIP that your

children are eligible for free or reducedprice meals, unlessyou tell us not to. Medicaid and CHIP only use the information

to identify children who may be eligible for their programs. Program officials may contact you to offer to enroll yourchildren, Filling out the Free and Reduced Price School Meals Application does not automatically enroll your children inhealth insurance.

If you do not want us to share your information with Medicaid or CHIP, fill out the form below and send in.

(Sending in this form will not change whether your children get free or reduced price meals).

LI No! I DO NOT want information from my Free and Reduced Price School Meals Application shared with Medicaidor the State Children’s Health Insurance Program.

If you checked no, fill out the form below to ensure that your information is NOT shared for the child(ren) listed below:

Child’s Name:

______________________________________School:_______________________________________

Child’s Name:

___________________________________School:____________________________________

Child’s Name:

___________________________________School:____________________________________

Child’s Name:

___________________________________School:____________________________________

Signature of Parent/Guardian:

__________________________________Date: _____________________________

Printed Name:

Address:

For more information, you may call Irene Oliver at 508-836-7700 or e-mail: oliveri@westboroughk12.org

Return this form to: Your Childs School

WESIBOROUCH PUBLIC SCHOOLS45 WesI Main Street• Westborough, MA 01581 508-836-7700 www.westborouah.on

Sharing Information with OTHER PROGRAMS

Dear Parent/Guardian:

To save you time and effort the information you gave on your Free and Reduced Price School Meals Application may be

shared with other programs for which your children may qualify. For the following programs, we must have your

permission to share your information. Sending in this form will not change whether your children get free or reduced price

meals.

U Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application

with Community Education.

U Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application

with Extracurricular activities.

U Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application

with Preschool.

If you checked yes to any or all of the boxes above, fill out the form below to ensure that your information is shared for

the child(ren) listed below. Your information will be shared only with the programs you checked.

Childs Name:

______________________________________School:_______________________________________

Child’s Name:

___________________________________School:____________________________________

Child’s Name:

______________________________________School:_______________________________________

Childs Name:

___________________________________School:____________________________________

Signature of Parent/Guardian:

_____________________________________Date: ______________________

Printed Name:

Address:

For more information, you may call Irene Oliver at 508-836-7700 ext. 2020 or e-mail at oliveri@westboroughk12.org

Return this form to: Your Child’s School

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I-87

7-38

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63.

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.-’

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Deb

itco

rdm

akes

purc

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sea

sy’

If your child is eligible for free or reduced school

meals, your child may also he eligible forfree or low cost health insurance

learn more call: 1-800-841-2900

MassHeaItha

Si su niflo es eligible para almuerzo gratis oreducido, su nub pueda ser eligible para

seguro de salud gratis o de bajo costopor medic) de Massllealrh.

Para saber mas, ilame ak 1-800-841-2900

I,

To

through Massl-Iealrh.