In accordance with the National School Lunch Act, the Duanesburg Central School District provides free or reduced price school lunches/breakfasts for students from needy families. Families must apply each year even if they have participated during the previous school year. 

Instructions for applying for free and reduced-price meals
To apply for free and reduced-price meals for your children, submit a Direct Certification letter received from the Office of Temporary and Disability Assistance OR complete the family application for reduced-price school meals/milk. Applications can be found in the back to school issue of the district newsletter (to be mailed to residents in late August) or can be downloaded here.
 
(Please note: This is a PDF document, which requires Adobe Acrobat Reader to view. Acrobat Reader can be downloaded for free from the Adobe Acrobat Web site.)

Read the instructions below, complete only one form per household, sign your name and return the application form to:

Duanesburg Central School District
Food Services Manager Mary Jewell
163 School Drive
Delanson, NY 12053

If you need help, call the Food Service Department at 895-5350, ext. 228.

Please complete a separate application for each foster child.  Ensure that all information is provided. Failure to do so may result in denial or unnecessary delay in approving your application.

PART 1 ALL HOUSEHOLDS MUST COMPLETE STUDENT INFORMATION.
(1) Print the names of the children for whom you are applying.
(2) List their grade and school.

PART 2 HOUSEHOLDS WITH A FOSTER CHILD SHOULD COMPLETE THIS PART AND SIGN PART 5.
A foster child is the legal responsibility of a welfare agency or court. A separate application must be completed for each foster child.
(1) List the foster child’s monthly “personal use” income. (“Personal Use” income is money given by the welfare office identified by category for the child’s personal use, such as an allowance, and all other money the child gets, such as money from his/her family or money from the child’s employment.) Write “0” if the foster child does not get “personal use” income. SKIP PART 4. Do not list any other children, household members or income, or a social security number.
(2) A foster parent or other official representing the child must sign the application in PART 5.

PART 3 HOUSEHOLDS RECEIVING FOOD STAMPS, TANF OR FDPIR SHOULD COMPLETE THIS PART AND SIGN PART 5.
(1) List a current food stamp case number, TANF or FDPIR (Food Distribution Program for Indian Reservations) number. Complete a separate application for a child/children with a different case number.
(2) An adult household member must sign the application in PART 5. SKIP PART 4. Do not list names of household members or income if you list a food stamp case number, TANF or FDPIR number.
 
PARTS 4 & 5 ALL OTHER HOUSEHOLDS MUST COMPLETE THESE PARTS AND ALL OF PART 5.
(1) Write the names of everyone in your household, whether or not they receive income. Include yourself, the children you are applying for, all other children, your spouse, grandparents, and other related and unrelated people in your household. Use another piece of paper if you need more space.
(2) Write the amount of current income each household member receives, before taxes or anything else is taken out, and indicate where it came from, such as earnings, welfare, pensions and other income. If the current income was more or less than usual, write that person’s usual income. Specify how often this income amount is received: weekly, bi-weekly, monthly, 2 x per month.
(3) The value of any child care provided or arranged, or any amount received as payment for such child care or reimbursement for costs incurred for such care under the Child Care and Development Block Grant, TANF and At Risk Child Care Programs should not be considered as income for this program.
(4) The application must include the social security number of the adult who signs PART 5 if Part 4 is completed. If the adult does not have a social security number, write “none.” If you listed a food stamp, TANF or FDPIR number, or if you are applying for a foster child, a social security number is not needed.

OTHER BENEFITS
Your child may be eligible for benefits such as Medicaid or Children’s Health Insurance Program (CHIP). In order to determine if your child is eligible, program officials need information from your free and reduced price meal application. Your written consent is required before any information may be released. Please refer to the attached parent Disclosure Letter and Consent Statement for information about other benefits.

PRIVACY ACT STATEMENT
Section 9 of the National School Lunch Act requires that unless your children’s food stamp, TANF or FDPIR case number is provided, you must include the social security number of the adult household member signing the application, or indicate that the household member does not have a social security number. If a social security number is not given or an indication is not made that the signer does not have such a number, the application cannot be approved. The social security number may be used to identify the household member in carrying out efforts to verify the accuracy of information stated on the application. These verification efforts may be carried out through program reviews, audits and investigations and may include contacting employers to determine income, contacting a food stamp or welfare office to determine current certification for receipt of food stamps or other benefits, contacting the state employment security office to determine the amount of benefits received and checking the documentation produced by household members to prove the amount of income received. These efforts may result in a loss or reduction of benefits, administrative claims, or legal actions if incorrect information is reported.

DISCRIMINATION COMPLAINTS
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. To file a complaint, write to USDA, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue SW, Washington D.C. 20250-9410, or call 202-720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.