• Application for Free and Reduced-Price Meals

    Complete one application per household
  • Please read the instructions on how to apply. Print clearly with a pen. This institution is an equal opportunity provider.

    California Education Code Section 49557(a): Applications for free and reduced-price meals may be submitted at any time during a school day. Children participating in the federal National School Lunch Program will not be overtly identified by the use of special tokens, special tickets, special serving lines, separate entrances, separate dining areas, or by any other means.

  • Student Information


  • Student 1 Information


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  • We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced-price meals.


  • Student 2 Information


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  • We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced-price meals.


  • Student 3 Information


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  • We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced-price meals.


  • Student 4 Information


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  • We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced-price meals.


  • Step-2 ASSISTANCE PROGRAMS: CalFresh, CalWORKs, or FDPIR



  • Step-3 REPORT INCOME FOR ALL HOUSEHOLD MEMBERS

    STUDENT INCOME: Sometimes students in the household earn income. Enter the TOTAL GROSS income (before deductions) in whole dollars earned by all students



  • ALL OTHER HOUSEHOLD MEMBERS (including yourself): List ALL household members not listed in STEP 1, even if they do not receive income. For each household member, report the TOTAL GROSS income (before deductions) in whole dollars for each source. If the household member does not receive income from any sources, write “0”. If you enter “0” or leave any fields blank, you are certifying (promising) that there is no income to report.



  • Member 1 Information



  • Member 2 Information



  • Member 3 Information



  • Member 4 Information



  • Adult Information Completing Form


  • Clear
  • Annual Income Conversion:
    Weekly x52
    Bi-weekly x26
    Twice a Month x24
    Monthly x12

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  • Should be Empty: