Riverside Elementary School 90 Hendrie Avenue, Riverside, CT * (fax)

Transcripción

1 Riverside Elementary School 90 Hendrie Avenue, Riverside, CT * (fax) Christopher Weiss Principal Marianne McCullough Assistant Principal August 20, 2015 Dear Parents, On behalf of the faculty and support staff of Riverside School, I want to welcome you and your family to the school year! As a parent of elementary age children as well, I know the wonder of a summer vacation with the whole family as well as the excitement everyone feels at the beginning of a new school year. As we celebrate our 82 nd year as a school here in Riverside we look forward to working in partnership with the PTA and with each of you to offer the best possible education for your children. At the beginning of the summer, our assistant principal, Ms. McCullough, our media specialist, Mrs. Browning, and I (along with 10 others from Greenwich Public Schools) attended the ISTE (International Society of Technology in Education) National Conference in Philadelphia, PA. There we met many others on the same journey we are on as a school and a district, implementing a 1:1 Digital Learning Environment with a continued focus on excellence in teaching and learning. We learned from experts across the country (and many learned from their interactions with us as well) on using technology as a powerful tool to strengthen and individualize the learning experience for students. We bring much of that new knowledge and insight back to our school and the district as GPS implements a 1:1 learning environment with ipads (K-5) and Chromebooks (6-12) district wide. Building upon this new learning, we will be strengthening our theme of Innovation this year. The students of Riverside have made us all proud. Not only do they strive to be kind, caring, and respectful, they have shown all of Greenwich, through their effective utilization of the ipads and their experience innovating with Genius Hour and our S.T.E.M. Fair, what can be accomplished with new knowledge, hard work, and creative problem solving. In addition, with the help of our PTA and the district (and a gift from the 5 th grade parents in June), we will be launching our Innovation Space in our media center in September. Our vision in all of this is to see Riverside become a place where each member of our community is an innovator who helps improve our school, town, country, and ultimately the world. We welcome continued input, ideas, and collaboration from parents and community organizations in support of this vision. Please welcome with me the following teachers joining our outstanding Riverside staff: Ms. Kimberly Sturman 1 st grade teacher (permanent hire), Ms. Ciara Hickey 1 st grade teacher, Ms. Julia Corso Art Teacher (FT), Ms. Taryn Deitrick.2 Art Teacher. We would also like to welcome Ms. Valerie Caro as our new building intern. Mrs. Tara Santillo (1 st grade) has returned to North St. School where she had a long tenure and is teaching a new 1 st grade section there. Congratulations to our FLES teacher, Mrs. Kathryn Siguenza, who is a new mom! Ms. Lilliana Amodeo will start the year as the Long Term FLES Substitute for Mrs. Siguenza. We also want to welcome Mr. Ismael Franqui as our Native Spanish teacher. Additionally, we welcome Mrs. Carrie Hancock as our new.8 ALP teacher joining Mrs. Miserocchi. We also welcome Mrs. Freer Goodbody (formerly grade 1) as she joins the grade 3 team and we welcome Mrs. Denice Crettol (moving from grade 4) to a 5 th section of grade 2.

2 Please refer to the weekly Peek, published electronically, for the dates and times of important meetings and for updates throughout the year. Also, please note that our OPEN HOUSE evening this year will be on Thursday, October 2. More information on the specific times for which grades will be provided in early September. When you arrive in September, you will see an improved Riverside School with some nice new plantings out front, a finished brick walk extension to Hendrie Avenue, some updated air conditioning, new paint in many places inside, and our Riverside Community Garden growing beautifully on the side of the school (thanks to the PTA and the volunteer families who took care of it this summer)! In addition, work has been moving along on replacing the taken down half of our K-2 playground next to Hendrie Avenue. The new equipment will likely be installed by mid-september. On Wednesday, September 2, at 8:45am we will ring the opening bell on our 82 nd year of this amazing neighborhood school. Please join our learning community on the front lawn for our Parade of Learners. Students should arrive between 8:30 8:40 to meet their teachers and classmates. Enjoy the remaining days of summer and we look forward to greeting you on September 2 for the Parade of Learners. In case of rain, you may escort your children to their classrooms, (rain date is September 3). As always, classes will begin promptly at 8:45. Sincerely, Christopher Weiss, Principal

3 Welcome New Families Grades 1-5 You and your child are invited to a special sneak preview of your new school on Tuesday, September 1, :00 a.m. Newcomer students entering Grades 1 3, please gather at the front entrance to meet your Assistant Principal, Ms. McCullough. 11:30 a.m. Newcomer students entering Grades 4 & 5, please meet Ms. McCullough at the front entrance. Please wear a name tag with your name clearly printed. Note: A welcome reception for new parents hosted by the PTA will be held on the front lawn between 11:30-12:30. Everyone at Riverside School is looking forward to welcoming you to your new school and community! Back to Table of Contents

4 Parade of Learners Wednesday, September 2, :30 a.m. First Bell - students meet their teachers on the field 8:45 a.m. Welcome Message - Mr. Weiss & Ms. McCullough Pledge of Allegiance Parade of Learners - Each teacher will lead his/her class into the building through the main door for a full day of school. Dismissal at 3:15 pm./3:10 for kindergarten. 8:55 a.m. All parents are invited to attend the Welcome Back Fair in the café. A few reminders for opening day: Please prepare nametags for your child to wear each day from September 2 September 11. Please walk to school; parking will be very limited. If you do drive, please obey No Parking signs. Don t forget your camera. In case of inclement weather, check the website for more information. (www:greenwichschools.k12.ct.us/rs) In the event of rain parents may escort their children into their classrooms beginning at 8:30. School will begin at 8:45 with the Pledge. The Welcome Back Fair will be held in the cafe beginning at 8:55. Because we love a parade raindate for the Parade of Learners will be Thursday, September 3, 2015 at 8:45 am. From day one we want to set the tone with ceremony and seriousness, we need your help. Thank you.

5 Riverside Elementary School 90 Hendrie Avenue, Riverside, CT * (fax) Christopher Weiss Principal Marianne McCullough Assistant Principal August 20, 2015 Dear Parents, Over the past decade we have experienced and increase in the number of students who have severe allergies to a whole host of food items from peanuts & tree nuts to shellfish. I am writing to let you know that there are students in all grades and most classes who have allergies. Strict avoidance of these foods in all forms is the only way to prevent allergic reactions. These allergies may be life threatening, even when only touching an area where one of these foods has had contact. In an effort to provide a safe learning environment for all children, we are asking that you consider NOT sending in peanut items for a snack as these account for most of the allergies. The same care must be taken if you are providing food for class parties or class special events. You may, however, send these products in for your child s own lunch, which is eaten in the cafeteria and where a peanut-free table has already been established. Please support our efforts by encouraging your child not to share any food with classmates. Birthday parties are a special time for children, but can be a difficult time for the food allergic child. It would be especially helpful if you could let the teacher know a few days before you want to celebrate your child s birthday so that parents can provide for their own child s safe treat. If your child eats peanut butter before coming to school, please remind them to wash their hands with soap and water as an extra precaution. By following these guidelines, we are striving to provide an enjoyable and safe learning environment, while minimizing the risks associated with food allergies. Thank you very much for your care and understanding of this matter. Wishing you and your family a safe and healthy school year. Sincerely, Christopher Weiss Principal

6 GREENWICH PUBLIC SCHOOLS EMERGENCY INFORMATION CARD Student's Name: Last First Female Male Please circle one Teacher/Grade: DOB: Age: Address: Street City Zip / Mother Father MOTHER'S CONTACT INFORMATION FATHER'S CONTACT INFORMATION NAME ( ) HOME PHONE ( ) ( ) CELL PHONE ( ) ( ) WORK PHONE ( ) EMERGENCY CONTACT INFORMATION - If I cannot be reached, please contact these local people: Name & Phone: ( ( ) ) / ( ) FULL NAME HOME Name & Phone: ( ( ) ) / ( ) FULL NAME HOME CELL CELL Physician: Phone #: ( ) Address: Fax #: ( ) Dentist: Phone #: ( ) ALLERGIES: MEDICATIONS: OTHER INFO: Street, City, Zip DATE OF LAST DIPHTHERIA/TETANUS BOOSTER: Does your child have health insurance? Circle one: YES If your child is uninsured, we will provide you information on Connecticut's HUSKY plan. Your signature means that the school can provide you contact information for the Connecticut Department of Social Service or information about how to enroll in HUSKY. NO Parent Signature: Date: *NOTE: In the event of a medical emergency or illness, I hereby authorize the Greenwich Public Schools to provide first aid, and/or to request emergency medical treatment and transportation to a hospital. Any hospital or emergency medical personnel are authorized to provide treatment to my child of such nature as they deem appropriate and to consult with the physician listed above. Parent Signature: Date:

7 GREENWICH PUBLIC SCHOOLS INFORMACIÓN DE EMERGENCIA Nombre del estudiante: Apellido Nombre de pila Niña Niño Por favor circule una Maestro/Grado: fecha de nacimiento: Edad: Dirección: Calle Ciudad Código Postal / Información de contacto de la Madre Madre Padre NOMBRE ( ) TELÉFONO DE CASA ( ) ( ) TELÉFONO CELULAR ( ) ( ) TELÉFONO DEL TRABAJO ( ) Información de contacto de la Padre Información de contacto de emergencia - Si no me pueden localizar, por favor llamen a estas personas locales: Nombre y Teléfono: ( ( ) ) / ( ) NOMBRE COMPLETO CASA CELULAR Nombre y Teléfono: ( ( ) ) / ( ) NOMBRE COMPLETO CASA CELULAR Médico: Teléfono: ( ) Dirección: Fax #: ( ) Dentista: Teléfono: ( ) ALERGIAS: MEDICAMENTOS: Calle, Ciudad, Código Postal OTRA INFORMACIÓN: FECHA DE LA ÚLTIMA VACUNA DE DIFTERIA Y TÉTANOS: Su hijo tiene seguro de salud? Por favor circule una : SI NO Si su hijo no tiene seguro, nosotros le proporciona información sobre el plan HUSKY de Connecticut. Su firma significa que la escuela puede proporcionar información para el Departamento de Servicios Sociales de Connecticut o información sobre cómo inscribirse en HUSKY en contacto. Parent Signature: Date: *NOTE: En caso de una emergencia médica o enfermedad, por la presente autorizo a las Escuelas Públicas de Greenwich para prestar primeros auxilios y/o para solicitar tratamiento médico de emergencia y el transporte a un hospital. Cualquier hospital o personal médico de emergencia están autorizados a proporcionar tratamiento a mi hijo de tal naturaleza que consideren apropiadas y consultar con el médico que aparece arriba. Firma del padre: Fecha:

8 Rev. 1/22/2015 Approved by Board: 1/22/2015 S M T W T F S Month: S M T W T F S Month: S M T W T F S days / students days / students days / teachers days / teachers days / teachers Cumulative: Cumulative: days / students days / students days / teachers days / teachers days / teachers Grade 6&9 Orientation - Early Release 14 Summer School Ends 2 First Day for All Students 12 Columbus Day-Schools Open 27 First Day for All Teachers 7 Labor Day-Schools Closed 21 Teacher Meetings - Early Release 31 Professional Learning Day 14 Rosh Hashanah-Schools Closed 16 Teacher Meetings - Early Release 23 Yom Kippur - Schools Closed S M T W T F S Month: S M T W T F S Month: S M T W T F S days / students days / students days / students days / teachers days / teachers days / teachers Cumulative: Cumulative: Cumulative: days / students days / students days / students days / teachers days / teachers days / teachers 31 3 Election Day/Prof. Learning - Schools Closed 3 Elementary Conferences - Early Release 1 New Year's Day - Schools Closed 11 Veterans Day - Schools Open 8 Elementary Conferences - Early Release 4 School Resumes 25 Early Release 10 Elementary Conferences - Evening 13 Teacher Meetings - Early Release Thanksgiving Recess - Schools Closed 23 Early Release 18 MLK, Jr. Day - Schools Closed Holiday Recess - Schools Closed FEBRUARY Greenwich Public Schools District Calendar AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER MARCH JANUARY S M T W T F S Month: S M T W T F S Month: S M T W T F S days / students days / students days / students days / teachers days / teachers days / teachers Cumulative: Cumulative: Cumulative: days / students days / students days / students days / teachers days / teachers days / teachers APRIL Month: Cumulative: Month: Month: 8-12 Winter Recess - Schools Closed 9 Teacher Meetings - Early Release Spring Recess - Schools Closed 15 President's Day - Schools Closed 25 Good Friday - Schools Closed 26 Presidential Primary Day - Schools Closed MAY S M T W T F S Month: S M T W T F S Month: S M T W T F S days / students days / students days / teachers days / teachers Cumulative: Cumulative: days / students days / students days / teachers days / teachers Teacher Meetings - Early Release 24 GHS Graduation* (Tentative) 4 Independence Day - No Summer School 30 Memorial Day-Schools Closed 24 Last Day for Grade 6 (Includes 5 Snow Days)** 27 Last Day for Students (Includes 5 Snow Days)** Early Release 5 Summer School Begins 181 Days / Students 187 Days / Teachers 28 Last Day for Staff (Includes 5 Snow Days)** * GHS Graduation will be held NO LATER than 6/24/16, however, it could be held earlier, depending on the last day of school. The graduation date will be confirmed / set on 4/1/16 JUNE JULY ** If more snow / storm days are needed, they will be taken from either the remaining days in June or from the Spring Recess in April. Please plan accordingly.

9 Checklist Template for August Packets District Documents The checklist below may be incorporated into Principals August Packet letters to parents and/or used as content for posting to the school web site. School specific documents should be included as appropriate. IMPORTANT INFORMATION and REQUIRED FORMS Parents should review and be familiar with the following information. The relevant forms must be printed, completed and returned to the school by Friday, September 4, 2015 School Handbook School Handbook Acknowledgement Form Press Publicity Permission/Denial Form IMPORTANT INFORMATION and OPTIONAL FORMS Parents are strongly encouraged to review the following information and complete and submit the relevant forms to authorize permission or opt out of participation as preferred. Authorization for Medical Care Form School Lunch Debit Account Form Free or Reduced Price Lunch Form Internet Acceptable Use Procedure and Opt Out Form Student Accident Insurance IMPORTANT INFORMATION Parents are strongly encouraged to read and be familiar with the following information. Greenwich Public Schools School Calendar Jewish Holidays Greenwich Board of Education Meeting Calendar District Communications/Emergency Information Overview Safety & Security Letter Health Curriculum Letter

10 GREENWICH PUBLIC SCHOOLS PARENT/GUARDIAN LETTER TO HOUSEHOLDS FOR SCHOOL MEALS AND SNACKS Dear Parent/Guardian: Children need healthy meals to learn. Greenwich Public Schools offers healthy meals every school day. Children may buy lunch for $3.25 for elementary schools, $3.40 for middle schools, $3.50 for high school and breakfast for $1.60- $2.10 at participating schools. Your children may qualify for free meals or for reduced price meals. Reduced price is $0.30 for breakfast and $0.40 for lunch. This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions and answers to help you with the application process. Note: Children receiving Supplemental Nutrition Assistance Program (SNAP) or Temporary Family Assistance (TFA) benefits may be directly certified and automatically eligible for free meals without further applying for benefits. Questions regarding SNAP/TFA and direct certification should be sent to: John Hopkins If you have received a NOTICE OF DIRECT CERTIFICATION for free meals, do not complete the application. However, do let the school know if any children in your household are not listed on the Notice of Direct Certification letter you received. 1. WHO CAN GET FREE OR REDUCED PRICE MEALS? All children in households receiving SNAP or TF A benefits from are eligible for free meals. Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals. Children participating in their school's Head Start program are eligible for free meals. Children who meet the definition of homeless or runaway are eligible for free meals. Children may receive free or reduced price meals if your household's income is within the limits on the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart: I I REDUCED FEDERAL ELIGIBILITY INCOME CHART Effective 7/ to 6/30/2016 Household size Yearly Monthly Weekly 1 21,775 1, ,471 2, ,167 3, ,863 3, ,559 4,380 1, ,255 5,022 1, ,951 5,663 1, ,647 6,304 1,455 Each additional person: +7, HOW DO I KNOW IF MY CHILDREN QUALIFY AS HOMELESS OR RUNAWAY? Do the members of your household lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and haven't been told your children will get free meals, please call or Denise Qualey to see if they qualify at: (203) or dqualey@kidsincrisis.org. 3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to your school's office. 4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY APPROVED FOR FREE MEALS? No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from your eligibility notification, contact the Food Service Office at: or john_hopkins@greenwich.kl2.ct.us immediately.

11 5. MY CHILD'S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child's application is only good for that school year and for the first few days of this school year. You must send in a new application unless the school told you that your child is eligible for the new school year. 6. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please send in an application. 7. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you report. 8. IF I DON'T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free and reduced price meals if the household income drops below the income limit. 9. WHAT IF I DISAGREE WITH THE SCHOOL'S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing by calling or writing to: Vicki Gregg, Food Service Manager, , 290 Greenwich Ave. Greenwich, CT MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other household members do not have to be U.S. citizens to apply for free or reduced price meals. 11. WHAT IF MY INCOME IS NOTAL WAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income. 12. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not receive some types of income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so. 13. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or clothing, or receive Family Subsistence Supplemental Allowance payments, it must also be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. Any additional combat pay resulting from deployment is also excluded from income. 14. WHAT IF THERE ISN'T ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a separate piece of paper, and attach it to your application. Contact your school office to receive a second application or visit our website to down load one: MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for SNAP benefits and to contact the Department of Social Services office in your town, contact United Way's free referral number (free call, statewide). If you have other questions or need help, call SinceWL &, S. McKcc,ie, Ph.D. Superintendent of Schools July 1, 2015

12 GREENWICH SCHOOL FOOD SERVICES DEBIT ACCOUNT SYSTEM ELEMENTARY SCHOOLS Students in Greenwich Elementary Schools who pre-pay for their meals and students who qualify for free or reduced price meals will receive a Personal Identification Number (PIN) to use for meals and/or a la carte purchases in the school cafeteria. If you used the Debit Account System last year your PIN Number will remain the same. These numbers will remain the same through your tenure in the Greenwich Public School System, and any balances left on account at the end of one school year will carry through to the next. Money can be deposited into an account for lunches and/or a la carte purchases, several ways: TO FUND YOUR ACCOUNT BEFORE SCHOOL BEGINS: Please note: All active accounts from last year will be available the 1 st day of school. New Accounts or Low Balance Accounts can send this Debit Account Deposit Form with your payment to: Greenwich Public Schools, School Food Services, 290 Greenwich Avenue, Greenwich, CT 06830, post dated NO LATER THAN AUGUST 18, 2015 to ensure proper credit to the account. Parents can pay for school lunches using a (*) credit/debit card and/or check student account information through the website myschoolbucks.com To get started all you need is your child s name, school, 9 digit student ID number, and date of birth. Student ID numbers are listed on your child s summer teacher assignment letter or can be secured by calling the Food Service Office at (203) Visit myschoolbucks.com for more information. The system will be open for deposits on August 20, * Please note: There is no fee to use this service to maintain student account information, however, a fee of $1.95 will be charged for each credit card transaction. This fee is to cover bank charges. The school district does not receive any of the fees. TO FUND YOUR ACCOUNT AFTER SCHOOL BEGINS: Deposits can be made anytime during the school year. To make a deposit, bring your payment to the cafeteria or logon to: mylunchmoney.com Students who were approved for Free or Reduced Price Meals during the school year and any students or adults who have deposited money into an account before school begins may use their account on the first day of school. There is a charge for Reduced Price Meals of 40 which may be pre-paid to an account after filing a new application for the school year or paid to the cashier when picking up a meal. Students eligible for Free or Reduced Price meals may also use their card for a la carte purchases if money has been deposited into their account for this purpose. Applications for Free or Reduced price meals are available at your school office or on the district s website. All other NEW students and adults may pick up their (PIN) at the school cafeteria once a deposit has been made to their account. Should you have any questions during the summer regarding the Debit Account System, please call the Food Services Office at During the school year, please call your child s school cafeteria. Please make check payable to: TOWN OF GREENWICH, SCHOOL LUNCH FUND. Returned checks are subject to a $25.00 returned check fee DEBIT ACCOUNT DEPOSIT FORM Please fill out a separate form for EACH child and return with payment. ELEMENTARY SCHOOL: Student Name RETURNING STUDENTS 5 Digit Lunch PIN NUMBER: Account Cash for Meals ($3.25 ea.) and/or A La Carte Purchases Please check this box if you only want your child to purchase meals with this account. Grade Amount $ Please make check payable to: TOWN OF GREENWICH, SCHOOL LUNCH FUND

13 Greenwich Public Schools Application for Free and Reduced-price School Meals or Free Milk Complete one application per household. Please use a pen (not a pencil). Application No: STEP 1 List ALL Household Members who are infants, children, and students up to and including grade 12 (if more spaces are required for additional names, attach another sheet of paper) Definition of Household Member: Anyone who is living with you and shares income and expenses, even if not related. Children in Foster care and children who meet the definition of Homeless, Migrant or Runaway are eligible for free meals. Read How to Apply for Free and Reduced Price School Meals for more information. Student? Child s First Name MI Child s Last Name Foster Head Even Homeless or School Grade Yes No Check all that apply Start Start Runaway STEP 2 Do any Household Members (including you) currently participate in one or more of the following Assistance Programs - SNAP OR TFA: Check one: YES or NO (This does NOT include medical (HUSKY) benefits.) To quicken the approval process, it is strongly recommended that you submit proof of SNAP or TFA eligibility with this application. See instructions. If NO household member participates in SNAP or TFA, skip Step 2 and complete STEP 3. If a household member does participate in SNAP or TFA, write a SNAP OR TFA case number here and then go to STEP 4 (Do not complete STEP 3) STEP 3 Report Income for ALL Household Members (Skip this step if you wrote a SNAP or TFA Number in STEP 2) Case Number: Write only one case number in this space. Please read How to Apply for Free and Reduced Price School Meals for more information. The Sources of Income for Children section will help you with the Child Income question. The Sources of Income for Adults section will help you with the All Adult Household Members section. A. Child Income Sometimes children in the household earn income. Please include the TOTAL income earned by all Child Household Members listed in STEP 1 here. $ Child income Weekly Bi-Weekly 2x Month Monthly How often? Weekly Bi-Weekly 2x Month Monthly B. All Adult Household Members (including yourself) 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 for each source in whole dollars only. 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. Name of Adult Household Members (First and Last) How often? Earnings from Work Weekly Bi-Weekly 2x Month Monthly Public Assistance/ Child Support/Alimony How often? $ $ $ $ $ $ $ $ $ Pensions/Retirement/ All Other Income How often? Weekly Bi-Weekly 2x Month Monthly $ $ $ $ $ $ Total Household Members (Children and Adults Step 1 & Step 3) Last Four Digits of Social Security Number (SSN) of Primary Wage Earner or Other Adult Household Member X X X X X Check if no SSN STEP 4 Contact Information information and Adult adult Signature signature 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. Street Address (if available) Apt # City State Zip Daytime Phone and (optional) Printed name of adult completing the form Signature of adult completing the form Today s date

14 OPTIONAL Children's Racial and Ethnic Identities 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. Ethnicity (check one): Race (check one or more): Hispanic or Latino Not Hispanic or Latino American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White 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 a social 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. 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 derived 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 at filing cust.html, or at any USDA office, or call (866) 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 , by fax (202) or 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) ; or (800) (Spanish). USDA is an equal opportunity provider and employer. For School Use Only Do Not Write Below This Line Determining Officials (DO) for the Local Education Agency MUST complete this section. Annual Income Conversion: Weekly X 52 Every 2 weeks X 26 Twice a Month X 24 Monthly X 12 (Only convert to annual income if there are different frequencies of income listed in Step 3.) Date Certified on DC List: Directly Certified Based on the State Direct Certification List SNAP/TFA Household (Reminder: The DO must confirm a handwritten SNAP/TFA number) Foster Child Head Start Confirmed Homeless or Runaway Income Household: Total household income: per Household Size: Application approved for: Free Meals Reduced-Price Meals Application Denied Date Notice Sent: Signature of Determining Official: Date:

15 Rev. 5/19/2015 Application Instructions Page 1 of 4 HOW TO APPLY FOR FREE AND REDUCED-PRICE SCHOOL MEALS Please use these instructions to help you fill out the application for free or reduced-price school meals. You only need to submit one application per household, even if your children attend more than one school in [School District]. The application must be filled out completely to certify your children for free or reduced-price school meals [or free milk if the school participates in the Special Milk Program.] Please follow these instructions in order! Each step of the instructions is the same as the steps on your application. If at any time you are not sure what to do next, please contact [school/school district contact here---phone and preferred]. PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY. STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS, CHILDREN, AND STUDENTS UP TO AND INCLUDING GRADE 12 Tell us how many infants, children, and school students live in your household. They do NOT have to be related to you to be a part of your household. Who should I list here? When filling out this section, please include all members in your household who are: Children age 18 or under and are supported with the household s income; In your care under a foster arrangement, or qualify as homeless or runaway youth; Students attending [school/school system here], regardless of age. A. List each child s name. For each child, print their first name, middle initial and last name. Use one line of the application for each child. Please print clearly. If there are more children present than lines on the application, attach a second piece of paper with all required information for the additional children. B. List the name of the school and grade (if applicable) that each child attends and check the box to confirm if the child is a student at the school. C. Do you have any foster children? If any children listed are foster children, mark the Foster Child box next to the child s name. Foster children who live with you may count as members of your household and should be listed on your application. If you are only applying for foster children, after completing STEP 1, skip to STEP 4 of the application and these instructions. D. Are any children enrolled in a federal Head Start or Even Start Program in the school system? If you believe any child listed in this section may meet this description, please mark the Head Start or Even Start box next to the child s name and complete all steps of the application. E. Are any children homeless or runaway? If you believe any child listed in this section may meet this description, please mark the Homeless or Runaway box next to the child s name and complete all steps of the application.

16 Rev. 6/5/2015 Application Instructions Page 2 of 4 STEP 2: HOUSEHOLD MEMBER PARTICIPATION IN ONE OR MORE ASSISTANCE PROGRAMS SNAP OR TFA (THIS DOES NOT INCLUDE MEDICAL OR HUSKY BENEFITS) If anyone in your household participates in the assistance programs listed below, your children are eligible for free school meals: The Supplemental Nutrition Assistance Program (SNAP) or Temporary Family Assistance (TFA) A. IF NO ONE IN YOUR HOUSEHOLD PARTICIPATES IN ANY OF THE ABOVE LISTED PROGRAMS: Skip to STEP 3 on these instructions and STEP 3 on your application. Leave STEP 2 blank. B. IF ANYONE IN YOUR HOUSEHOLD PARTICIPATES IN ANY OF THE ABOVE LISTED PROGRAMS: Check off Yes and provide a case number for SNAP or TFA. You only need to write one case number. If you participate in one of these programs and do not know your case number, contact your DSS Social Worker. Note: Do not use a HUSKY Medical Benefits Number since this number is not a SNAP or TFA case number. It is also recommended (but not required) that you submit proof of this SNAP or TFA case number when you submit the application for processing. Proof does NOT include a copy of the CONNECT card. Skip to STEP 4. STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS A. Report all income earned by children. Refer to the chart titled Sources of Income for Children in these instructions and report the combined gross income for ALL children listed in Step 1 in your household in the box marked Total Child Income. Only count foster children s income if you are applying for them together with the rest of your household. It is optional for the household to list foster children living with them as part of the household. What is Child Income? Child income is money received from outside your household that is paid directly to your children. Many households do not have any child income. Use the chart below to determine if your household has child income to report. Sources of Child Income Sources of Income for Children Examples Earnings from work A child has a job where they earn a salary or wages. Social Security o Disability Payments o Survivor s Benefits A child is blind or disabled and receives Social Security benefits. A parent is disabled, retired, or deceased, and their child receives social security benefits. Income from persons outside the household A friend or extended family member regularly gives a child spending money. Income from any other source A child receives income from a private pension fund, annuity, or trust.

17 Rev. 6/5/2015 Application Instructions Page 3 of 4 FOR EACH ADULT HOUSEHOLD MEMBER: Who should I list here? When filling out this section, please include all members in your household who are: Living with you and share income and expenses, even if not related and even if they do not receive income of their own. Do not include people who: Live with you but are not supported by your household s income and do not contribute income to your household. Children and students already listed in Step 1. How do I fill in the income amount and source? FOR EACH TYPE OF INCOME: Use the charts in this section to determine if your household has income to report. Report all amounts in gross income ONLY. Report all income in whole dollars. Do not include cents. o Gross income is the total income received before taxes or deductions. o Many people think of income as the amount they take home and not the total, gross amount. Make sure that the income you report on this application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay. Write a 0 in any fields where there is no income to report. Any income fields left empty or blank will be counted as zeroes. If you write 0 or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials have known or available information that your household income was reported incorrectly, your application will be verified for cause. Mark how often each type of income is received using the check boxes to the right of each field. Note: Income must be listed as being received either: weekly; bi-weekly; 2 X month; or monthly. Do not list income annually. B. List Adult Household member s name. Print the name of each household member in the boxes marked Names of Adult Household Members (First and Last). Do not list any household members you listed in STEP 1. If a child listed in STEP 1 has income, follow the instructions in STEP 3, part A. C. Report earnings from work. Refer to the chart titled Sources of Income for Adults in these instructions and report all income from work in the Earnings from Work field on the application. This is usually the money received from working at jobs. If you are a self-employed business or farm owner, you will report your net income. What if I am self-employed? If you are self-employed, report income from that work as a net amount. This is calculated by subtracting the total operating expenses of your business from its gross receipts or revenue. D. Report income from Public Assistance/Child Support/Alimony. Refer to the chart titled Sources of Income for Adults in these instructions and report all income that applies in the Public Assistance/Child Support/Alimony field on the application. Do not report the value of any cash value public assistance benefits NOT listed on the chart. If income is received from child support or alimony, only courtordered payments should be reported here. Informal but regular payments should be reported as other income in the next part.

18 Rev. 6/5/2015 Application Instructions Page 4 of 4 E. Report income from Pensions/Retirement/All other income. Refer to the chart titled Sources of Income for Adults in these instructions and report all income that applies in the Pensions/Retirement/All Other Income field on the application. F. Report total household size. Enter the total number of household members in the field Total Household Members (Children and Adults). This number MUST be equal to the number of household members listed in STEP 1 and STEP 3. If there are any members of your household that you have not listed on the application, go back and add them. It is very important to list all household members, as the size of your household determines your income cutoff for free and reduced-price meals or free milk. G. Provide the last four digits of your Social Security Number. The household s primary wage earner or another adult household member must enter the last four digits of their Social Security Number in the space provided. You are eligible to apply for benefits even if you do not have a Social Security Number. If no adult household members have a Social Security Number, leave this space blank and mark the box to the right labeled Check if no SS#. Sources of Income for Adults Earnings from Work Public Assistance/Alimony/Child Support Pensions/Retirement/All Other Income Salary, wages, cash bonuses Net income from self-employment (farm or business) Strike benefits If you are in the U.S. Military: Basic pay and cash bonuses (do NOT include combat pay, FSSA or privatized housing allowances) Allowances for off-base housing, food, and clothing Unemployment benefits Worker s compensation Supplemental Security Income (SSI) Cash assistance from State or local government Alimony payments Child support payments Veteran s benefits Social Security (including railroad retirement and black lung benefits) Private Pensions or disability Income from trusts or estates Annuities Investment income Earned interest Rental income Regular cash payments from outside household STEP 4: CONTACT INFORMATION AND ADULT SIGNATURE All applications must be signed by an adult member of the household. By signing the application, that household member is promising that all information has been truthfully and completely reported. Before completing this section, please also make sure you have read the privacy and civil rights statements on the back of the application. A. Provide your contact information. Write your current address in the fields provided if this information is available. If you have no permanent address, this does not make your children ineligible for free or reduced-price school meals. Sharing a phone number, address, or both is optional, but helps us reach you quickly if we need to contact you. B. Sign and print your name. Print your name in the box Printed name of adult completing the form and sign your name in the box Signature of adult completing the form. C. Write Today s Date. In the space provided, write today s date in the box. D. Share children s Racial and Ethnic Identities (optional). On the back of the application, we ask you to share information about your children s race and ethnicity. This field is optional and does not affect your children s eligibility for free or reduced-price school meals.

19 CARTA DE LAS ESCUELAS PUBLICAS DE GREENWICH PARA PADRES Y TUTORES SOBRE LAS COMIDAS Y REFRIGERIOS ESCOLARES Estimados padre, madre o tutor: Para poder aprender, los nifios necesitan alimentarse bien. Las escuelas publicas de Greenwich ofrecen comidas saludables todos los dfas durante la escuela. Para los estudiantes de primaria el almuerzo cuesta 3,25 d6lares, 3, 40 para los estudiantes de secundaria o Middle School y 3,50 para los estudiantes de bachillerato o High School. El desayuno cuesta entre 1,60 y 2,10 d6lares en las escuelas que lo ofrecen. Es posible que sus hijos tengan derecho a recibir co midas gratuitas o a precio reducido. El precio reducido es 0,30 por el desayuno y 0,40 por el almuerzo. Con esta carta incluimos el formulario para solicitar las comidas gratuitas o a precio reducido junto con las instrucciones detalladas. A continuaci6n mostramos algunas preguntas frecuentes y sus respuestas con el objeto de ayudarles con la solicitud. Aviso: Los estudiantes que est{m recibiendo asistencia a traves del programa de Nutrici6n Suplementaria (Nutrition Assistance Program o SNAP por sus siglas en ingles) o asistencia familiar temporal (Temporary Family Assistance o TF A por sus siglas en ingles) podnin directamente ser aprobados y tener automaticamente derecho a las comidas gratuitas sin tener que solicitarlas. Las preguntas relacionadas con los programas de SNAP o TF A y Ia aprobaci6n automatica se tendr:in que dirigir a John Hopkins al Si han recibido un aviso de APROBACION AUTOMA TICA para las comidas gratuitas, no rellenen Ia solicitud pero avisen a Ia escuela si tienen mas hijos en Ia escuela y estos no aparecen listados en Ia carta que recibieron de Aprobacion Automatica 1.,;.COMO PUEDO OBTENER COMIDAS GRA TUITAS 0 A PRECIO REDUCIDO? Todos los nifios que reciben beneficios de SNAP o TF A tienen derecho a comidas gratuitas Los nifios en acogida, (Foster Children), que estill bajo la responsabilidad legal de una agencia de acogida o tribunal, tienen derecho a recibir comidas gratuitas Los nifios que participan en el programa de Head Start en su escuela tienen derecho a recibir comidas gratuitas Los nifios que se definen sin hogar o fugados tienen derecho a recibir comidas gratuitas Los nifios que vivan en un hogar donde los ingresos econ6micos se situen dentro o por debajo de los limites establecidos por las directrices federales podnin tener derecho a comidas gratuitas o a precio reducido. Consulte el gnifico que se muestra a continuaci6n para ver si sus ingresos estan dentro o por debajo del limite establecido. I GRA.FICO SOBRE LOS INGRESOS ECONOMICOS que dictan el derecho a los I beneficios. Efectivo desde ell de julio del2015 hasta e130 de junio del2016 Numero de personas Ingresos Ingresos Ingresos Semanales en el hogar familiar Anuales Mensuales , , , , ,380 1, ,022 1, ,663 1, ,304 1,455 Cada persona adiciona

20 2. L,COMO SE SI MIS HIJOS SON DEFTNIDOS COMO NINOS SIN HOGAR 0 FUGADOS? L,Carecen los miembros de su hogar de una direcci6n permanente? L,Esta viviendo con su hijo en un refugio, en un hotel o en un hogar temporal? L,Se traslada su familia de un Iugar dependiendo de las temporadas? L,Esta viviendo con algun nifio que decidi6 abandonar a su anterior familia u hogar? Si cree que los nifios de su hogar cumplen estas caracterfsticas y no le han avisado que recibiran comidas gratuitas, p6ngase en contacto por telefono o con Denise Qualey a1 (203) o qguajey:(_llkidsincrisis.org. para determinar si tienen derecho a comidas gratuitas. 3. L,NECESITO RELLENAR UNA SOLICITUD POR CADA HIJO? No. Cuando rellene Ia solicitud para recibir comidas gratuitas o a precio reducido, utilice la misma solicitud para todos los estudiantes que vivan con usted. No podremos aprobar ninguna solicitud que no este cumplimentada, por lo que rogamos asegurese que rellena toda Ia informacion requerida. Entregue Ia solicitud cumplimentada en Ia secretaria de su escuela. 4. L,TENGO QUE RELLENAR UNA SOLICITUD SI ESTE ANO RECIBI UNA CARTA ESCOLAR DICIENDO QUE MIS HIJOS HAN SIDO APROBADOS PARA RECIBIR COMIDAS GRATUITAS? No, pero lea detenidamente Ia carta que recibi6 y siga las indicaciones. Si alguno de sus hijos viviendo con usted no aparece en esa carta, p6ngase en contacto inmediatamente con el Departamento de Servicios Alimenticios al o john hopkins@greemvich.k 12.ct.us 5. LA SOLICITUD DE MI HIJO FUE APROBADA EL ANO PASADO. z,tengo QUE RELLENAR OTRA? Si. La solicitud de su hijo es valida solo para ese afio escolar y para los primeros dias de este afio escolar. Tiene que enviar una solicitud nueva a menos que Ia escuela le haya dicho que su hijo tiene derecho a recibir comidas gratuitas o a precio reducido para el nuevo afio escolar. 6. z,pueden MIS HIJOS RECIBIR CO MIDAS GRA TUIT AS SI SOY BENEFICIARIO DEL PROGRAMA WIC? Los nifios que viven en familias que se benefician del programa WIC tambien podrian tener derecho a recibir comidas gratuitas o a precio reducido. En este caso rellene y entregue Ia solicitud. 7. z,se VA A COMPROBAR LA INFORMACION QUE DE? Si. Tam bien posiblemente, le pidamos que envie pruebas por escrito de los ingresos econ6micos que declar6 en Ia solicitud. 8. z,podria PRESENTAR OTRA SOLICITUD MAS ADELANTE, EN CASO DE QUE MI SOLICITUD NO SEA APROBADA AHORA? Si. Puede solicitar en cualquier momento durante el afio escolar. Por ejemplo, los nifios cuyo padre, madre o tutor haya perdido el empleo, tal vez puedan tener derecho a recibir comidas gratuitas o a precio reducido si los ingresos familiares se situan en ellimite o por debajo del limite de los ingresos permitidos. 9. z,que SUCEDERIA SINO ESTOY DE ACUERDO CON LA DECISION DE LA ESCUELA SOBRE MI SOLICITUD? Deberia hablar con los funcionarios escolares. Tambien puede solicitar una audiencia llamando o escribiendo a Vicki Gregg, Encargada de los Servicios Alimenticios a! o 290 Greenwich Ave. Greenwich, CT z,podria RELLENAR UNA SOLICITUD AUNQUE UN MIEMBRO DE MI FAMILIA QUE VIVE CONMIGO NO SEA CIUDADANO EST ADOUNIDENSE? Sf. Ni usted ni sus hijos, ni ningun otro miembro de Ia familia tienen que ser ciudadano estadounidense para tener derecho a recibir comidas gratuitas o a precio reducido. 11. z,que SUCEDE SI MIS INGRESOS VARIAN? Declare Ia cantidad que recibe normalmente. Por ejemplo, si normalmente gana 1,000 d6lares cada mes, pero el mes pasado solo gan6 900 d6lares porque no pudo asistir a! trabajo, declare de todos modos que gana 1,000 a! mes. Si normalmente recibe pagas por horas extra, incluyalas tambien pero no las incluya si solamente hace horas extras de vez en cuando. Si perdi6 el empleo o le han reducido las horas de trabajo o el sueldo, declare el sueldo reducido. 12. z,que SUCEDE SI ALGUN MIEMBRO DE MI FAMILIA NO APORT A INGRESOS ECONOMICOS? Es posible que alglin miembro de su familia no aporte alguno de los ingresos que le pedimos que declare o ninglin ingreso en absoluto. Si esto sucede, rogamos escriba un 0 en Ia casilla correspondiente. No obstante si alguna casilla se deja en blanco, esta tambien se contara como 0. Tenga cui dado cuando deje casillas en blanco ya que asumiremos que su intenci6n es dejarla en blanco. 13. z, TENDRIAMOS QUE DECLARAR NUESTROS INGRESOS DE MANERA DIFERENTE SI PERTENECEMOS A LAS FUERZAS ARMADAS? Tiene que indicar como ingresos su salario Msico y sus pagas extras. Si esta viviendo fuera de la base