Household income disclosure forms available

Household Income Form (Word Doc – Fill out, Print)

Household Income Form (Printable PDF)

Our school participates in the Community Eligibility Provision (CEP) under the National School Lunch Program.  Under CEP, all students receive a free breakfast and lunch each day, for the entire school year.

However, to determine eligibility to receive additional benefits, such as assistance with college course and other school program fees, families need to complete a Household Income Form.  This form also helps the school to qualify for special grants and funds.

  • Do I need to fill out a form for each child? No. Use one Household Income Form for all students living in your household.
  • My child(ren) already receive free meals at school, why should I complete this form? Many state and federal programs use household income information to determine eligibility for programs. By completing this form, our school is able to determine eligibility for additional programs that benefit everyone.
  • Who should I include as members of my household? You must include all people living in your household, related or not, who share income and expenses.  You must include yourself and all children living with you.  You do not have to include other people living with you who are financially independent.
  • What if my income is not always the same? List the amount that you normally. If you normally get overtime, include it, but do not include overtime if you only get it occasionally.
  • What do I do with the form, once it’s complete? Return the form to the main office of either building – by dropping it off, sending it with a student, or mailing. Elementary students may return it to their classroom teacher.

If you have any questions about this Household Income Eligibility Form, please contact Lauri Broady at 518-993-4000 #1003 or lauri.broady@fortplain.org