HOW TO FILL OUT THIS APPLICATION: Please print neatly with black or blue ink. Complete one application per household. INCOMPLETE, ILLEGIBLE, OR INCORRECT APPLICATIONS CANNOT BE PROCESSED AND WILL DELAY MEAL BENEFITS. Until your application is processed and you have been notified of your benefit status, please provide your child(ren) with money to purchase meals or provide a meal from home. Meal prices are listed at the top of the next section.

STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS, CHILDREN, AND STUDENTS UP TO AND INCLUDING GRADE 12. Please include ALL members in your household who are: Children 18 or under AND are supported with the household’s income. If any students listed are foster children, check the “Foster Child” box. Foster children who live with you may count as members of your household and should be listed on your application. If you are only applying for foster children, complete STEP 1 and then skip to STEP 4. If you believe any student listed in this section may be Homeless, Migrant, or Runaway check the appropriate box and complete all steps of the application.

STEP 2: DO ANY HOUSEHOLD MEMBERS CURRENTLY PARTICIPATE IN SNAP or TANF? If no, leave blank and go to STEP 3. If yes, write a state of Georgia case number for SNAP or TANF. You need to provide only one case number. Go to STEP 4. If you do not know your SNAP or TANF case number contact Georgia DFCS at (877) 423-4746.

STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS. A) Report all income by children. (Many households do not have child income.) Report the combined gross income for ALL children listed in STEP 1. Only count foster children’s income if you are applying for them together with the rest of your household. It is optional for the household to list foster children living with them. B) Total of all household members. C) Last four digits of social security number or check “NO SSN” of adult household member. D) List all other Household member names and income. Do not list any household members you listed in STEP 1. List income in whole dollars. Do NOT list “take home” pay, list the “gross” amount before taxes.

SOURCES OF INCOME FOR CHILDREN: Earnings from work (A child has a job where they earn a salary or wage.), Social Security (Disability Payments or Survivor’s Benefits.), Income from persons outside the household (A friend or extended family member regularly gives a child spending money.), income from any other source (A child receives income from a private pension fund, annuity, or trust.)

SOURCES OF INCOME FOR ADULTS: Earnings from Work (Gross earnings, make sure that the income you report on this application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay), Public Assistance/Alimony/Child Support (Unemployment benefits, Worker’s compensation, SSI cash assistance from State or local government, alimony payments, child support payments, Veteran’s benefits.), Pensions/Retirement/All Other income (Social Security, Private pensions or disability, income from trusts), Self-employment income (report income from work as a net amount subtracting business expenses.)

REPORT TOTAL HOUSEHOLD SIZE: This MUST be equal to the number of household members listed in STEP 1 and STEP3. Provide the last four digits of your Social Security Number. If no adult household member has a Social Security Number, then check the box labeled “Check if no SSN.”

STEP 4: CONTACT INFORMATION AND ADULT SIGNATURE. All applications must be signed by an adult member of the household. Provide your contact information and date the application with today’s date.

OPTIONAL: Share Children's racial and ethnic identities along with your student(s) Free & Reduced status.

1. WHO CAN RECEIVE FREE OR REDUCED-PRICE MEALS? All children in households receiving benefits from SNAP or TANF, are eligible for free meals. Foster children that are 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, migrant, runaway or Head Start are eligible for free meals. Children may receive free or reduced-price meals if your household’s 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 below the limits on this chart.

2. HOW DO I KNOW IF MY CHILDREN QUALIFY 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 temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and haven’t been told your children will get free meals, please call the appropriate office: Department of Innovative Practice 770-422-3500 ext. 7285.
3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to the cafeteria manager at any Marietta City school.
4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE APPROVED FOR FREE MEALS? No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from the eligibility notification, contact the Cafeteria Manager.
5. CAN I APPLY ONLINE? Yes! You are encouraged to complete an online application instead of a paper application if you are able. The online application has the same requirements and will ask you for the same information as the paper application. Visit https://family.titank12.com/application/new?lang=English to begin or to learn more about the online application process. Contact Jasmine Richardson 678-695-7274 or jrichardson@marietta-city.k12.ga.us if you have questions.
6. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is only good for that school year and for the first few days of this school year, through 9/14/2023. You must send in a new application unless the school told you that your child is eligible for the new school year.
7. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please send in an application.
8. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you report.
9. 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 unemployed may become eligible for free and reduced price meals if the household income drops below the income limit.
10. 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: Chuck Gardner, 250 Howard St, Marietta Ga 30060; 770-422-3500; cgardner@marietta-city.k12.ga.us.
11. 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 qualify for free or reduced price meals.
12. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $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.
13. WHAT IF SOME HOUSEHOLD MEMBERS HAVE 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 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so.
14. 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.
15. WHAT IF THERE ISN’T ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a separate piece of paper, and attach it to your application. Contact Jasmine Richardson at 250 Howard St, Marietta, Ga 30060, 678-695-7274 or jrichardson@marietta-city.k12.ga.us to receive a second application.
16. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for SNAP or other assistance benefits, contact your local assistance office or call 1-877-423-4746.

If you have other questions or need help, call 678-695-7274 for more information. Si necesita ayuda, por favor llame al teléfono: 678-695-7274. Si vous voudriez d’aide, contactez nous au numero: 678-695-7274.

Sincerely,

Jasmine Richardson, Regulations Specialist

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.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. mail:
   U.S. Department of Agriculture
   Office of the Assistant Secretary for Civil Rights
   1400 Independence Avenue, SW
   Washington, D.C. 20250-9410; or
2. fax:
   (833) 256-1665 or (202) 690-7442; or
3. email:
   Program.Intake@usda.gov

This institution is an equal opportunity provider.