Norwalk- La Mirada Unified School District

Online Free and Reduced Application

Letter to Household (Use the scrollbar to view the entire letter) PRINT



Dear Parent or Guardian:

The Norwalk-La Mirada Unified School District takes part in the National School Lunch and School Breakfast Programs. Breakfast and Lunches are served at all school sites. Students may buy lunch for $2.50 in elementary and $3.00 in middle and high school and/or breakfast for $1.25. Please note Norwalk-La Mirada waives the reduced price of .40¢. There is no charge to parents. Eligible students will receive meals at no cost. You or your children do not have to be a U.S. citizen to qualify for free or reduced-price meals.

TERMS—“Household” means a group of related or non-related individuals who are living as one economic unit and sharing living expenses. “Living expenses” include rent, clothes, food, doctor bills, utility bills, etc.

SOCIAL SECURITY NUMBER (SSN)—Provide the last four digits of your Social Security Number (SSN). An adult household member must enter the last four digits of their Social Security Number in the space provided. You are eligible to apply for benefits even if you do not have a Social Security Number. If no adult household members have a Social Security Number, leave this space blank and mark the box to the right labeled “Check box if no SSN.”

DIRECT CERTIFICATION—This district participates Direct Certification. If your household currently receives benefits from one of the following programs: SNAP, TANF, FDPIR, or KinGAP then 1) your children may be automatically certified to receive free meals. 2) if you did not receive a direct certification letter for your child who is in any of these programs, you must complete an application. If you do not receive notification by August 7, 2018, but think your children is/are eligible for free meals, please contact the Nutrition Services Office. You may need to complete an application.

MIXED HOUSEHOLDS WITH DIRECTLY CERTIFIED, FOSTER, OR/AND NON DIRECTLY CERTIFIED CHILDREN—To apply, complete the application for Free and Reduced-Price Meals, sign it and return it to the school or Nutrition Services Office. Households must complete an application when EACH child who does not have a case number or/and is not a foster child

FDPIR BENEFITS—Households participating in the FDPIR are categorically eligible for free meals. The FDPIR is authorized by Section 4(b) of the Food Stamp Act of 1977. Under this section, eligible households may elect to participate in either the SNAP Program or the FDPIR. Since households are afforded the option to participate in either program, FDPIR households have been determined to receive the same categorical benefits as SNAP households.

FOSTER CARE CHILDREN or CHILDREN PLACED IN OUT-OF-HOME CARE—Who are the legal responsibility of a welfare agency or court. Foster children are categorically eligible for free meals without further application, but the eligibility is not extended to other non-foster children in the household. Households with foster/non-foster children are encouraged to complete an application since foster children are counted as a household member. Thismay help the foster family’s non-foster children qualify for free or reduced-price meals based on the household size and income. If you choose to add both your foster/non-foster children on the application, you will need to report the foster/ non-foster’s income (personal income provided to the child or earned by the child), if any. The foster parent must sign the application and provide the last four digits of their SSN.

INCOME HOUSEHOLDS—To apply, complete the application for Free and Reduced-Price Meals. Follow the instructions on the application, sign it, and return it to the school or Nutrition Services Office. Applications are also available online at: WWW.NLMUSD.HEARTLANDAPPS.COM

MILITARY HOUSING INCOME—If your housing is part of the Military Housing Privatization Initiative, DO NOT include your housing allowance as income. All other allowances must be included in your gross income.

HOMELESS, RUNAWAY, & MIGRANT—Contact the school for details.

MEALS FOR DISABLED—If you believe your child needs a food substitute or texture modification because of a disability, please contact the Nutrition Services Department. A child with a disability is entitled to a special meal at no extra charge if the disability prevents the child from eating the regular school meals.

WIC PARTICIPANTS—If you currently receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (known as WIC), your child may be eligible for free/reduced-price meals

APPLYING FOR BENEFITS—You may apply for meal benefits at any time during the school year. If you are not eligible now, but your income decreases during the school year, you lose your job, your family size becomes larger, or you become eligible for CalFresh, CalWorks, or FDPIR benefits, you may submit an application at that time.

A COMPLETE HOUSEHOLD APPLICATION—The application cannot be processed unless it contains complete eligibility information. If you do not enter a CalFresh, CalWorks, or FDPIR case number for any student (or an adult household member) listed on the application, you must complete the following:

Note: You must complete an application with all household members and their income listed, for a child who is living with relatives or friends, whether or not the child is a ward of the court.

Section A: All Households Must Complete This Section. List ALL Household Members who are infants, children, and students up to and including grade 12. Enter their Birthdate, School, and Grade. Please enter their Student ID Number if known

Section B: Household Members and Their Monthly Income. Child Income-Sometimes children in the household earn or receive income. Please include the TOTAL gross income (before taxes) in whole dollars (no cents) received by all Household Members in Section A. here. All Adult Household Members (including yourself) – List all Household Members not listed in Section A. Enter the total gross income (before taxes) in whole dollars (no cents) under each income type and the frequency of the income. If no 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

Section C: All Households Read and Complete This Section. All applications must be signed by an adult member of the household. Please provide home and/or work phone #, mailing address, and the last four digits of the SSN of the adult household member signing the application, or check the box if no SSN (if the adult signer does not have an SSN). Please include the Total Household Members (Children & Adults). Optional: Children’s Racial and Ethnic Identities. This field is optional and does not affect your children’s eligibility for free or reduced-price school meals.

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


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

VERIFICATION—School officials may check the information on the application at any time during the school year. You may be asked to send information to prove your income, or current eligibility for CalFresh, CalWorks, or FDPIR benefits. For a foster child, you will need to provide written documentation that verifies the foster child is the legal responsibility of an agency/court or provide the name and contact information for a person at the agency/court who can verify that the child is a foster child.

USE OF INFORMATION STATEMENT— 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.

FAIR HEARING—If you do not agree with the District’s decision regarding your application or the result of verification, you may discuss it with the Nutrition S ervices Department. You also have the right to a fair hearing. A fair hearing may be requested by calling or writing the following school official: Estuardo Santillan, Assistant Superintendent, 12820 Pioneer Blvd., Norwalk, CA 90650, 562-210-2000.

For July 1, 2018 - June 30, 2019

Household size Annual Monthly Twice per Month Every Two Weeks      Weekly
1 $22,459 $1,872 $936 $864 $432
2 $30,451 $2,538 $1,269 $1,172 $586
3 $38,443 $3,204 $1,602 $1,479 $740
4 $46,435 $3,870 $1,935 $1,786 $893
5 $54,427 $4,536 $2,268 $2,094 $1,047
6 $62,419 $5,202 $2,601 $2,401 $1,201
7 $70,411 $5,868 $2,934 $2,709 $1,355
8 $78,403 $6,534 $3,267 $3,016 $1,508
Each additional person: +$7,992 +$666 +$333 +$308 +$154

CONFIDENTIALITY: Family size, household income, and Social Security number information will remain confidential and will not be shared for any purpose. Information you provide will determine your child(ren)’s eligibility to receive free or reduced-price meals.

OVERT IDENTIFICATION/NON-DISCRIMINATION—Children who receive free or reduced-price meals must be treated in the same manner as children who pay full price for meals, and not overtly identified

NON-DISCRIMINATION 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, 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) 6329992. 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.

Do you Need Assistance completing the application or have questions? Please contact: Nutrition Services Department, 12820 Pioneer Blvd., Norwalk, CA 90650, 562-210-2410.

You will be notified when your application has been approved or denied for free or reduced-price meals. Parents are responsible for all meal changes until eligibility has been determined. Prior year’s eligibility will be honored for the first 30 days only and you must reapply by 9/27/18. 


Anna Apoian

Director, Nutrition Services Department

This institution is an equal opportunity provider.