Campbell Union SD, CA

Online Free and Reduced Application

Letter to Household (Use the scrollbar to view the entire letter) PRINT


Dear Parent or Guardian:
The Campbell Union School District takes part in the National School Lunch and/or school Breakfast Programs. Meals are served every school day at participating schools. Students may buy lunch for $3.50 and/or breakfast for $2.25. Eligible students may receive meals free or at a reduced-price of 40 cents for lunch and/or 30 cents breakfast. You or your children do not have to be a U.S. citizen to qualify for free or reduced-price meals.
TO APPLY: Please complete the application and return to either your child’s schools front office or to the Child Nutrition Services Office, located at 240 N Harrison Ave, Campbell CA 95008. Only one application is required for all children in the household. For 30 operating days into the new school year, eligibility from the previous year will continue. When the carry over period ends, unless the household is notified that their children are directly certified or the household submits an application that is approved, the children must pay full price for school meals.

DIRECT CERTIFICATION— This school/agency participates Direct Certification. If your household currently receives benefits from one of the following programs: CalFresh, California Work Opportunity and Responsibility to Kids (CalWORKs), Kinship Guardianship Assistance Payments (Kin-GAP), or Food Distribution Program on Indian Reservations (FDPIR). DO NOT complete a meal Application. School officials will notify you of your children’s eligibility for free meals. If you are not contacted by September 10, 2018 but think your children are eligible for free meals, please contact the Child Nutrition Services office. You may need to complete an Application.

MIXED HOUSEHOLDS WITH DIRECTLY CERTIFIED, FOSTER, OR/AND NON DIRECTLY CERTIFIED CHILDREN—To apply complete the Application for Free and Reduced-Price Meals, sign it, and return it to the school’s office or the Child Nutrition Services Office. Households must complete an Application when EACH child who does not have a case number or/and is not a foster child.

FOSTER CARE CHILDREN or CHILDREN PLACED IN OUT-OF-HOME CARE (who are the legal responsibility of a welfare agency or court) - Foster children are categorically eligible for free meals without further information, but the eligibility is not extended to other non-foster children in the household. Households with foster/non-foster children are encouraged to complete an Application, since foster children may be counted as a household member, which may help the foster family’s non-foster children qualify for free or reduced-price meals. If you choose to add both your foster/non-foster children on the Application, you will need to report the foster/ non-foster’s income (personal income provided to the child or earned by the child), if any, and the foster parent signs the Application and provides the last four digits of their SSN. If the foster family is not eligible for free or reduced price meal benefits, it does not prevent a foster child from receiving benefits.

INCOME HOUSEHOLDS— To apply, Complete the Application for Free and Reduced-Price Meals. Households whose income is at or below the Income Eligibility Guidelines may be eligible for either free or reduced price meals.  Follow the instructions on the Application and see the Income to report chart on the right, sign it, and return it either to your school’s front office or to the Child Nutrition Services office located at 240 N. Harrison Ave, Campbell CA 95008.

For July 1, 2018 - June 30, 2019

Household size Annual Monthly Twice per Month Every Two Weeks      Weekly
1 $22,459 $1,872 $936 $864 $432
2 $30,451 $2,538 $1,269 $1,172 $586
3 $38,443 $3,204 $1,602 $1,479 $740
4 $46,435 $3,870 $1,935 $1,786 $893
5 $54,427 $4,536 $2,268 $2,094 $1,047
6 $62,419 $5,202 $2,601 $2,401 $1,201
7 $70,411 $5,868 $2,934 $2,709 $1,355
8 $78,403 $6,534 $3,267 $3,016 $1,508
Each additional person: +$7,992 +$666 +$333 +$308 +$154

MEALS FOR DISABLED— If you believe your child needs a food substitute or texture modification because of a disability, please contact the           school. A child with a disability is entitled to a special meal at no extra   charge if the disability prevents the child from eating the regular meal.

WIC PARTICIPANTS— If you currently receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (known as WIC), your child may be eligible for free/reduced-price meals. We encourage you to complete an Application and return for processing.

APPLYING FOR BENEFITS— You may apply for meal benefits at any time during the school year. If you are not eligible now, but your income decreases during the school year, you lose your job, your family size becomes larger, or you become eligible for CalFresh, CalWORKs, Kin-GAP, or FDPIR benefits, you may submit an Application at that time.

A COMPLETE HOUSEHOLD APPLICATION—The Application cannot be approved unless it contains complete eligibility information.

STEP 1: List each child’s name, check ‘Yes’ or ‘No’ under the column titled “Student” to tell us which children attend the Campbell Union School District. If any children listed are foster children, check the “Foster Child” box next to the child’s name. If you believe any child may meet the description of being homeless, migrant, runaway or in Head Start, please check the box next to the child’s name. If any child is receiving Kin-GAP benefits, please enter the “Kin-GAP Case Number” in the box next to the child’s name.

STEP 2: If anyone in your household participates in CalFresh, CalWorks or FDPIR, all your children are eligible for free school meals. If YES: check the applicable program, enter your/your family member’s case number, and skip to STEP 4. If NO: leave Step 2 blank and skip to Step 3.

STEP 3: Section A: Report all income earned by children (child income is money received from outside your household that is paid directly to your children, many households do not have any child income). Section B: List all adult household members, whether or not they receive income. For each household member: write the amount of current income (if none, please write “0”) in whole dollars under each category, and how often received (frequency). If any current amount received was more or less than usual, write the usual or projected income. Report total household size: This number MUST be equal to the number of names listed in STEP 1 and STEP 3.

SOCIAL SECURITY NUMBER (SSN)—The Application must include the last four digits of the SSN of the primary wage earner or another adult household member. If the adult does not have a SSN, check the box for “if no SSN”.  If you have listed a CalFresh, CalWORKs, Kin-GAP, or FDPIR case number for the child, or if the application is for a foster child, an SSN is not required of the adult signing the application.


Earnings from work before deductions; include all jobs Gross Salary, wages, cash bonuses; strike benefits; self-employed net income from farm or business. IF you are in the US Military: Basic pay and cash bonuses (do not include combat pay, FSSA or privatized housing allowances); Allowances for off-base housing, food and clothing
Public Assistance/Alimony/ Child Support Unemployment benefits; Worker’s compensation; SSI; Cash assistance from state or local government; Alimony payments; Child support payments; Veteran’s benefits
Pensions/Retirement/All Other Income Social security; Private pensions or disability; Income from trusts or estates; Annuities; Investment income; Earned Interest; Rental Income; Regular cash payments from outside household

STEP 4: All applications MUST be signed by an adult member of the household. Provide your contact information, sign and print your name and write today’s date.

VERIFICATION—School officials may check the information on the Application at any time during the school year. You may be asked to send information to validate your income, or current eligibility for CalFresh, CalWORKs, Kin-GAP, or FDPIR benefits. For a foster child, you will need to provide written documentation that verifies the foster child is the legal responsibility of an agency/court or provide the name and contact information for a person at the agency/court who can verify that the child is a foster child.
FAIR HEARING—If you do not agree with the school's decision regarding
your Application’s eligibility determination or the result of verification, you may discuss it with the school district. You also have the right to a fair hearing. A fair hearing may be requested by calling or writing the following school official: James Crawford, (408) 341-7210, 155 North Third Street, Campbell, CA 95008

OVERT IDENTIFICATION—Children who receive free or reduced-price meals must be treated in the same manner as children who pay full price for meals, and not overtly identified.

INFORMATION STATEMENT—The Richard B. Russell National School Lunch Act requires the information on this Application. You do not have to provide 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 primary wage earner or another adult household member. The last four digits of the SSN is not required when you apply on behalf of a foster child or when you list a CalFresh, CalWORKs, KinGAP, or 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 a SSN. Your family size, household income, and the last four digits of your SSN will remain confidential and will not be shared. 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

NON-DISCRIMINATION STATEMENT - The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found  online: http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202)690-7442, or email at program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.

Do you need assistance completing the application or have questions? Please contact,
Child Nutrition Services Department
240 Harrison Avenue
Campbell, CA 95008

You will be notified by mail when your Application has been approved or denied for free or reduced-price meals.

Benny Calderon
Child Nutrition Services Supervisor
Campbell Union School District
(408)364-4200 ext. 4010