Sanger News (Sanger, Tex.), Vol. 6, No. 37, Ed. 1 Thursday, August 2, 2018 Page: 7 of 12
twelve pages : ill.View a full description of this newspaper.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
Weekly
Monthly
Annually
5.
6.
Do Not Fill Out This Part. This Is For School Use Only.
Date Received:
Household Size:
Total Income:
Reviewing/Determining Official’s Signature/Date
Work Earnings
(Enter Amount)
Income Determination: Multiple income frequencies must be converted to annual amounts and combined to determine household income. Do not convert if only one income frequency is
provided by the household. If converting income to annual, round only the final number—Annual Income Conversion: Weekly x 52 | Every 2 Weeks x 26 | Twice a Month x 24 | Monthly x 12
Public Assistance/ Child
Support/Alimony
(Enter Amount)
Pensions/Retirement/ Social
Security/Supplemental
Security Income
(Enter Amount)
All Other
(Enter Amount)
Monthly
Twice a MonthAnnually
Categorical
DeterminationEligibility:
FreeReduced
Denied
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
5.
6.
D. Income for Children in the Household (Do not include adult income. Do report any type of regular income for children in the household.)
Record total income by frequency for the children with income listed in Step 1.
4.
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Weekly Every 2 Weeks
Confirming Official’s Signature/Date
Adult’s Flrst/Last Name
(Do not include the income of children in this
section. The income of children goes in 2D.)
4.
Twice per Month
$
$
$
Every 2 Weeks
$
$
$
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 asocial 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, 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 Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
This institution is an equal opportunity provider.
Step 2: Additional Names
C. Income for Adult Household Members (Include Yourself, But Not Children)
skip Step 2, and complete Step 3.
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
W-E-T-M-A
Street Address/Apt #
City
State
Zip
Daytime Phone and Email (Optional)
Printed Name of Adult Household Member Signing the Form
Signature of Adult Household Member Signing the Form
Today's Date
Additional Names
Check all that apply.
Ml
Last Name
Yes
No
Grade
Foster
Head Start
Homeless
Migrant
Runaway
Work Earnings
(Enter Amount)
Public Assistance/ Child
Support/ Alimony
(Enter Amount)
Pensions/Retirement/ Social
Security/Supplemental
Security Income
(Enter Amount)
Optional: Student
ID Number
All Other
(Enter Amount)
Step 1:
A. List ALL Household Members Who Are Infants, Children, and Students up to and Including Grade 12. If more spaces are needed, use the Additional Household Member Sheet on the back.
List each child’s name. Student Attends School in District?
First Name
B. Participation in a Categorical Program
• If every child listed in Step 1 is a participant any one of the following programs—Foster, Head Start, Homeless, Migrant, or Runaway, skip Step 2 and complete Step 3.
• SNAP, TANF, or FDPIR: Do any Household Members (including you) currently participate in SNAP, TANF, and/or FDPIR?
If No, complete Steps 2 and 3. If Yes to SNAP/TANF > Write the Eligibility Determination Group (EDG) number in this space
If Yes to FDPIR, check this box skip Step 2, and complete Step 3.
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Frequency
(Circle One)
W-E-T-M-A
Adult’s First/Last Name
(Do not include the income of children in this
section. The income of children goes in 2D.)
1.
2.
3.
D. Income for Children in the Household (Do not include adult income. Do report any type of regular income for children in the household. If more spaces are needed, use the Additional Names section on the back.)
Record total income by frequency for the children with income listed in Step 1. Weekly Every 2 Weeks Twice per Month Monthly Annually
1. $ $ $
2. $ $ $
3. $ $ $
Step 3: Please read the directions for more information on signing this form.
Provide Contact Information and Adult Signature. Return this application to your child’s campus office, cafeteria manager or Sanger ISD Administration Office, 601 Elm Street, Sanger, TX 76266.
I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the
information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.
Step 2: Please read the directions for more information for the following questions.
Report Income for ALL Household Members (Skip this step if you entered an EDG number or checked the box to indicate participation in FDPIR in Step 1).
A. Total Household Members (Children & Adults)
B. Last Four Digits of Social Security Number (SSN) of an Adult Household Member: XXX-XX Check if no SSN
C. Income for Adult Household Members (Include Yourself, But Not Children. If more spaces are needed, use the Additional Names section on the back.)
List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total income (without deductions) for each source in whole dollars
only. Indicate the frequency of income: W=Weekly, E=Every 2 Weeks, T=Twice per Month, M=Monthly, A=Annually. If they do not receive 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.
♦> email: sanger@lemonspublications.com
October 2018
su
su
su
M
T
W
TH
November 2018
December 2018
SU
su
su
M
T
W
M
T
W
TH
F
M
27
28
March 2019
SU
su
su
M
T
TH
M
T
W
TH
EOC Retest
Apr. 9-12
June 2019
SU
su
su
M
T
M
T
W
TH
F
29
30
June 24-28
Ml
Last Name
Grade
Foster
Runaway
Professional Development
7th/9th/New MS/HS START
All other students START
SPRING
1/9-2/15
2/19-4/12
4/16-5/23
This Box for School Use Only.
Date Withdrawn:
Sanger
Independent School District
601 Elm Street
Sanger, TX 76266
Testing
Dec. 3-7
Sanger ISD, 2018-2019 Multi-Child Application for Free and Reduced-Price School Meals
Complete one application per household. Please use a pen (not a pencil).
Definition of Household Member: anyone who is living with you and shares income and expenses, even if not related. Children in Foster care; children who meet the definition of Homeless, Migrant,
or Runaway or who participate in Head Start are eligible for free meals. Please read the directions for more information.
5
12
19
26
4
11
18
25
3
10
17
24
5
12
19
26
6
13
20
27
5
12
19
26
4
11
18
25
6
13
20
27
6
13
20
27
5
12
19
26
6
13
20
27
TH
2
9
23
30
TH
1
8
15
22
29
TH
2
9
16
F
1
8
15
22
S
4
11
18
25
S
3
10
17
24
S
2
9
16
23
S
4
11
18
25
2
~9~
16
23
30
2
9
16
23
30
3
10
17
24
31
2
9
16
23
30
3
10
17
24
3
10
17
24
31
4
11
18
25
3
10
17
24
4
11
18
25
4
11
18
25
5
12
19
26
4
11
18
25
5
12
19
26
5
12
19
26
6
13
20
27
5
12
19
26
6
13
20
27
6
13
20
27
6
13
F
1
8
15
22
29
S
2
9
16
23
30
S
1
8
15
22
29
S
1
8
15
22
29
S
1
8
15
22
29
6
13
20
27
M
1
8
15
22
29
M
1
8
15
22
29
M
1
8
15
22
29
January 2019
3
10
17
24”’
ir'
\i\i
3
10
17
24
31
W
2
9
16
23
30
TH
4
11
"18
is
TH
4
11
18
25
TH
4
11
18
25
F
4
11
18
25
5
6
13
20
27
5
6
13
20
27
S
5
12
19
26
5
6
13
20
27
May 6-10
May 13-17
February 2019
w
7
14
21
28
7
14
21
28
May 2019
_w
_8_
15
7
14
21
28
7
14
21
28
F
3
10
17
24
31
F
2
9
16
23
30
F
3
10
17
24
31
7
14
21
28
7
14
21
28
7
14
21
28
7
14
7
14
21
28
7
14
21
28
7
14
21
28
7
14
21
28
T
1
8
15
22
29
April 2019
vv
10
17
24
July 2019
_w
10
17
24
31
F
5
12
19
26
F
5
12
19
26
F
5
12
19
26
Eng 1,11, Wrtg4&7
Rdg 5 & 8
Math 5 & 8
EOC
Math, Rdg 3 & 4
Math, Rdg 3, 4, 6, & 7
Math, Rdg 5 & 8 Retest
Science 5 & 8
Social Studies 5 & 8
EOC&Math/Rdg 5&8 Retest
T
2
9
16
23
30
T
2
9
16
23
30
T
2
9
16
23
30
Sanger ISD 2018-2019
September 2018
F
School Holiday
Bad Weather Make-up
LAST DAY if makeup day is not needed
j^X^Early Dismissal
Grading Periods
FALL
8/15-9/21
9/25-11/2
11/6-12-21
Egg j* 1
< -3
Step 1:
A. List ALL Household Members Who Are Infants, Children, and Students up to and Including Grade 12. If more spaces are needed, use the Additional Names section on the back.
List each child’s name. Student Attends School in District? Optional' Student Check all that apply.
First Name Ml Last Name Yes No Grade ID Number Foster Head Start Homeless Migrant
| Thursday, August 2,2018 ♦♦♦ Sanger News ♦♦♦ www.lemonspublications.com
August 2018
M T _W
_8_
15
22
29
□ □ □ □ □
□ □ □ □ □
□ □ □ □ □
□ □ □ □ □
□ □ □ □ □
□ □ □ □ □
□ □ □ □ □
cn
co
□ □ □ □
□ □ □ □
□ □ □ □
□ □ □ □
□ □ □ □
□ □ □ □
□ □ □ □
N
co
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Newspaper.
Sanger News (Sanger, Tex.), Vol. 6, No. 37, Ed. 1 Thursday, August 2, 2018, newspaper, August 2, 2018; Sanger, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1238549/m1/7/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting Sanger Public Library.