2017-2018

Rocklin USD

Online Free and Reduced Application

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

School Year 2017-2018                                                                                                                                                  California Department of Education
                                                                                                                                             Pricing Letter to Household & Instructions, Revised February 2017
Dear Parent or Guardian:
The Rocklin Unified School District participates in the National School Lunch Program and/or School Breakfast Program by offering nutritious meals every school day. Students may buy lunch for $2.75 Elementary and $3.25 Secondary and breakfast for $1.75 for Elementary and $2.00 for Secondary. Eligible students may receive meals free of charge or at the reduced-price rate of $ .40 for lunch and $ .30 for breakfast. You or your children do not have to be U.S. citizens to qualify for free or reduced-price meals. If there are more household members than the number of lines on the application, attach a second application. For a simple and secure method to apply, use our online application at www.rocklinusd.org.  Choose Departments, then Nutrition Services.

LETTER TO HOUSEHOLD FOR FREE AND REDUCED-PRICE MEALS

QUALIFICATION: Your children may qualify for free or reduced-price meals if your household income falls at or below the federal Income Eligibility Guidelines below.

FEDERAL INCOME CHART
For School Year 2017-2018

Household size Annual Monthly Twice per Month Every Two Weeks      Weekly
1 $22,311 $1,860 $930 $859 $430
2 $30,044 $2,504 $1,252 $1,156 $578
3 $37,777 $3,149 $1,575 $1,453 $727
4 $45,510 $3,793 $1,897 $1,751 $876
5 $53,243 $4,437 $2,219 $2,048 $1,024
6 $60,976 $5,082 $2,541 $2,346 $1,173
7 $68,709 $5,726 $2,863 $2,643 $1,322
8 $76,442 $6,371 $3,186 $2,941 $1,471
Each additional person: +$7,733 +$645 +$323 +$298 +$149

APPLYING FOR BENEFITS: An application for free or reduced-price meals cannot be reviewed unless all required fields are completed. A household may apply at any time during the school year. If you are not eligible now, but your household income decreases, household size increases, or a household member becomes eligible for CalFresh, California Work Opportunity and Responsibility to Kids (CalWORKs), or Food Distribution Program on Indian Reservations (FDPIR) benefits, you may submit an application at that time.

DIRECT CERTIFICATION: An application is not required if the household receives a notification letter indicating all children are automatically certified for free meals. If you did not receive a letter, please complete an application.

VERIFICATION: School officials may check the information on the application at any time during the school year. You may be asked to submit information to validate your income or current eligibility for CalFresh, CalWORKs, or FDPIR benefits. 

WIC PARTICIPANTS: Households that receive Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits, may be eligible for free or reduced-price meals by completing an application.

HOMELESS, MIGRANT, RUNAWAY & HEAD START: Children who meet the definition of homeless, migrant, or runaway, and children participating in their school’s Head Start program are eligible for free meals. Please contact school official, Cindy Stonehill  for assistance at 916-624-1112 ext. 1.

FOSTER CHILD: The legal responsibility must be through a foster care agency or court to qualify for free meals. A foster child may be included as a household member if the foster family chooses to apply for their non-foster children on the same application and must report any personal income earned by the foster child. If the non-foster children are not eligible, this does not prevent a foster child from receiving free meals.

FAIR HEARING: If you do not agree with the school's decision regarding your application’s determination or the result of verification, you may discuss it with the hearing official. You also have the right to a fair hearing, which may be requested by calling or writing the following: Barbara Patterson, Deputy Superintendent, or designee, 2615 Sierra Meadows Dr, Rocklin, CA  95677, 916-624-2428.

ELIGIBILITY CARRYOVER: Your child’s eligibility status from the previous school year will continue into the new school year for up to 30 operating days or until a new determination is made. When the carryover period ends, your child will be charged the full price for meals, unless the household receives a notification letter for free or reduced-price meals. School officials are not required to send reminder or expired eligibility notices.

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) 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 Ave SW, Washington, D.C. 20250-9410; (2) Fax: (202) 690-7442; or
(3) E-mail: program.intake@usda.gov.

This institution is an equal opportunity provider.

HOW TO APPLY FOR FREE OR REDUCED-PRICE MEALS –

Complete one application per household. Please print clearly with a pen. Incomplete, illegible, or incorrect information will delay processing.


STEP 1: STUDENT INFORMATION – Include ALL STUDENTS who attend Rocklin Unified School District. Print their name (first, middle initial, last), school, grade level, and birthdate. If any student listed is a foster child, check the “Foster” box. If you are only applying for a foster child, complete STEP 1, and then continue to STEP 4. If any student listed may be homeless, migrant, or runaway, check the applicable “Homeless, Migrant, or Runaway” box and complete all STEPS of the application.
STEP 2: ASSISTANCE PROGRAMS – If ANY household member (child or adult) participates in CalFresh, CalWORKs, or FDPIR, then all children are eligible for free meals. Must check the applicable assistance program box, enter one case number, and then continue to STEP 4. If no one participates, skip STEP 2 and continue to STEP 3. 
STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS – Must report GROSS income (before deductions) from ALL household members (children and adults) in whole dollars. Enter “0” for any household member that does not receive income.
A) Report the combined GROSS income for all students listed in STEP 1 and enter the appropriate pay period. Include a foster child’s income if you are applying for foster and non-foster children on the same application.
B) Print the names (first and last) of ALL OTHER household members not listed in STEP 1, including yourself. Report the total GROSS income from each source and enter the appropriate pay period.
C) Enter the total household size (children and adults). This number MUST equal the listed household members from STEP 1 and STEP 3.
D) Enter the last four digits of your Social Security number (SSN). If no adult household member has a SSN, check the “NO SSN” box.
STEP 4: CONTACT INFORMATION & ADULT SIGNATURE – The application must be signed by an adult household member. Print the name of the adult signing the application, contact information, and today’s date.
OPTIONAL: CHILDREN’S ETHNIC AND RACIAL IDENTITIES – This field is optional to complete and does not affect your children’s eligibility for free or reduced-price meals. Please check the appropriate boxes.
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 are not required when you list a CalFresh, CalWORKs, or 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.
QUESTIONS/NEED ASSISTANCE: Please contact Cindy Stonehill  at 916-624-1112 Ext. 1.
SUBMIT: Please submit a complete application to your child’s school or the nutrition office at 4090 Del Mar Ave, Suite A, Rocklin, CA, 95677. You will be notified if your application is approved or denied for free or reduced-price meals. 

Sincerely,

Juanita Fahnestock, Nutrition Services Director, Rocklin Unified School District