Minneota Public Schools

You may apply for free and reduced meals at any time throughout the school year.  Click on the link below to access the form.  The instructions for completing the form are also below. 
 

How to Complete the Application for Educational Benefits

Complete the Application for Educational Benefits form for school year 2016-17 if any of the following applies to your household:

·         Any household member currently participates in the Minnesota Family Investment Program (MFIP), or the Supplemental Nutrition Assistance Program (SNAP), or the Food Distribution Program on Indian Reservations (FDPIR). or

·         The household includes one or more foster children (a welfare agency or court has legal responsibility for the child). or

·         The total income of household members is within the guidelines shown below (gross earnings before deductions, not take-home pay). Do not include as income: foster care payments, federal education benefits, MFIP payments, or value of assistance received from SNAP, WIC, or FDPIR. Military: Do not include combat pay or assistance from the Military Privatized Housing Initiative. The income guidelines are effective from July 1, 2016 through June 30, 2017.

Maximum Total Income

Household Size

$ Per Year

$ Per Month

$ Twice Per Month

$ Per 2 Weeks

$ Per Week

1

21,978

1,832

916

846

423

2

29,637

2,470

1,235

1,140

570

3

37,296

3,108

1,554

1,435

718

4

44,955

3,747

1,874

1,730

865

5

52,614

4,385

2,193

2,024

1,012

6

60,273

5,023

2,512

2,319

1,160

7

67,951

5,663

2,832

2,614

1,307

8

75,647

6,304

3,152

2,910

1,455

Add for each additional person

7,696

642

321

296

148

Step 1  Children

List all infants and children in the household, their birthdate and, if applicable, their grade and school. Attach an additional page if needed to list all children. Fill in the circle if a child is in foster care (a welfare agency or court has legal responsibility for the child). Please provide the requested information on ethnicity and race for each child. This information is not required and does not affect approval for school meal benefits. The information helps to make sure we are meeting civil rights requirements and fully serving our community.

Step 2  Case Number Circle Yes or No to show whether any household member currently participates in any of the three assistance programs listed in Step 2. If you answer Yes, write in the case number and go to Step 4 (skip Step 3). If you answer No, continue on to Step 3. WIC and Medical Assistance (M.A.) do not qualify for this purpose.

Step 3  Adults / Incomes / Last 4 Digits of Social Security Number

·      List all adults living in the household (everyone not listed in Step 1) whether related or not, such as grandparents, other relatives, or friends. Include any adult who is temporarily away from home, like a student away at college. Attach another page if necessary.

·      List gross incomes before deductions, not take-home pay. Do not list an hourly wage rate. For adults with no income to report, enter a ‘0’ or leave the section blank. This is your certification (promise) that there is no income to report for these adults.

·      For each income, fill in a circle to show how often the income is received: each week, every other week, twice per month, or monthly. 

·      For farm or self-employment income only, list the net income per year or month after business expenses. A loss from farm or self-employment must be listed as 0 income and does not reduce other income.

·      Last four digits of Social Security number – The adult household member signing the application must provide the last four digits of their Social Security number or check the box if they do not have a Social Security number.

·      Regular incomes to children – If any children in the household have regular income, such as SSI or part-time jobs, list the total amount of regular incomes received by all children. Do not include occasional earnings like babysitting or lawn mowing.

Step 4  Signature and Contact Information  An adult household member must sign the form. If you do not want your information to be shared with Minnesota Health Care Programs, check the “Don’t share” box in Step 4.



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