Nutrition Home :: Application Agreements
Student Nutrition Bureau
Application Agreements for SY 2009-2010
Return of Documents due on or before July 24, 2009
All files are Microsoft Office files, * denotes PDF files
Public, Private, Charter, and Bureau of Indian Affairs
- Application/Agreement for New Program Participation Child Nutrition Programs
- Application/Agreement Renewal for Combination/Standard & Provision 2 Base Year, Years 2 – 4
- Application/Agreement Renewal for Provision 2, Years 2 – 4
- Application/Agreement Renewal for Standard & Provision 2, Base Year
Residential Child Care Institution
Application/Agreement
New Program Participation Child Nutrition Programs
Public, Private or BIA
- Memo
- Checklist
- Contact Information
- Application Agreement SY 2009-2010 Pg 1-8
- LEA Signature Page Pg 9
- Officials Authorized to Sign Reimbursement Claim – Signature Page Pg 10
- Policy Statement for Free/Reduced Price Meals Pg 11-12
- Policy Statement for Free/Reduced Price Meals (Provision 2) Pg 13
- Designation of Hearing, Approving and Verifying Officials Pg 14
- Meals/Milk Count/Collection Procedure(s) Pg 15-16
- Parent Letter - English Pg 18
- Parent Letter - Spanish Pg 19
- Sharing Information with Medicaid/SCHIP Pg 20
- Family Application for Free/Reduced Pg 21-22
- Family Application for Free/Reduced (Spanish) Pg 23-24
- Notice of Approval/Denial for Free/Reduced (English)Pg 25
- Notice of Approval/Denial for Free/Reduced (Spanish)Pg 26
- Notice of Approval - Direct Certification Pg 27
- Public Release for Free/Reduced (English) Pg 28
- 14S Public Release for Free/Reduced (Spanish) Pg 29
- Household Verification Letter Pg 30-31
- Household Verification Results Pg 32
- Income Eligibility Guidelines Pg 33
- 18 Civil Rights Questionnaire Pg 34-36
Application/Agreement
Renewal for Combination/Standard & Provision 2 Base Year, Years 2 – 4
Public, Private or BIA
- Memo
- Checklist
- Contact Information Form for LEA
- Renewal Agreement Signature Page for SY 2009-2010 Pg 1-8
- Policy Statement for Free & Reduced Meals and/or Free Pg 9-10
- LEA Agreement Signature Page Pg 11
- Officials Authorized to Sign Reimbursement Claim- Signature Page Pg 12
- Provision 2 Base Year - Speical Assistance Certifcation & Reimbursement Alt Pg 13
- Designation of Hearing, Approving and Verifying Officials Pg 14
- Meals/Milk Count/Collection Procedure(s) Pg 14-16
- Parent Letter for Free and Reduced Price Meals - English Pg 18
- Parent Letter for Free and Reduced Price Meals - Spanish Pg 19 Sharing info w/Medicaid/SCHIP State Children’s Health Insurance Program Pg 20
- Application for Free and Reduced Price Meals/Milk for Family - English Pg 21-22
- Application for Free and Reduced Price Meals/Milk for Family - Spanish Pg 23-24
- Notice of Approval/Denial for Free and Reduced Price Meals or Milk - English Pg 25
- Notice of Approval/Denial for Free and Reduced Price Meals or Milk - Spanish Pg 26
- Direct Certification – Notification of Approval for Free Meals - Pg 27
- Public Release for Free and Reduced Price Meals/Milk - Pg 28
- Public Release for Free and Reduced Price Meals/Milk - Pg 29
- Household Letter for Verification Pg 30-31
- Household Letter for Notification of Verification Results - Pg 32
- Income Eligibility Guidelines Effective 7-1-09 though 6-30-10 Pg 33
- Meal Count and Collection Method, Years 2-4 Pg 34
- Letter to Household YEARS 2-4 - English Pg 35
- Letter to Household YEARS 2-4 - Spanish Pg 36
- Public Release English - Pg 37
- Public Release Spanish - Pg 38
Application/Agreement
Renewal for Provision 2, Years 2 – 4
Public, Private or BIA
- Memo
- Checklist
- Contact Information
- Renewal Agreement School Year 2009-2010
- Policy Statement for Free and Reduced Meals and/or Free Milk Pg 9-10
- Agreement Signature Page Pg 11
- Officials Authorized to Sign Reimbursement Claim – Signature Page Pg 12
- Designation of Hearing, Approving and Verifying Officials - Pg 13
- Provision 2 - Meals/Milk Count/Collection Procedure(s) YEARS 2-4 - Pg 14
- Provision 2, Letter to Household, YEARS 2-4 - English - Pg 15
- Provision 2, Letter to Household, YEARS 2-4 - Spanish - Pg 15a
- Public Release Announcing Provision 2-YEARS 2-4 (English) Pg 16
- Public Release Announcing Provision 2-YEARS 2-4 (Spanish) Pg 16a
Application Agreement for
New Program and Standard
Participation to National School Lunch and Breakfast Programs
for Residential Child Care Institution
- Memo
- Checklist
- Contact Information
- Application Agreement Pg 1-8
- Application/Agreement Signature Page - Pg 9
- Officials Authorized to Sign Reimbursement Claim – Signature Page - Pg 10
- Designation of Hearing, Approving, and Verifying Officials Pg 11
- Special Assistance/Reimbursement Alternative Policy Pg 12
- Policy Statement for Free and Reduced Price Meals and/or Free Milk - Pg 12 - 13
- Meals / Milk Count Accountability/Collection Procedures 7 Policy Statement Free/Reduced Pg 14-15
- Public Release for Free/Reduced (English) Pg 16
- Public Release for Free/Reduced (Spanish) Pg 16a
- Civil Rights Questionnaire Pg 17-19
- FORM C – Student Eligibility List
- FORM D Daily Meal Count Sheet*
- FORM E – RCCI Meal Count and Monthly Edit Check*
- SY 2009-2010 Income Eligibility Guidelines
Application/Agreement
Renewal for Standard & Provision 2, Base Year
Public, Private or BIA
- Memo
- Checklist
- Contact Information
- Renewal Agreement Signature Page for SY 2008-2009 Pg 1-8
- Policy Statement for Free & Reduced Meals and/or Free Milk Pg 9
- Agreement Signature Page - LEA Pg 11
- Officials Authorized to Sign Reimbursement Claim – Signature Page Pg 12
- Special Assistance Certification and Reimbursement Alternative Pg 13
- Designation of Hearing, Approving and Verifying Officials Pg 14
- Policy Statement for Free/Reduced Price Collection Procedures Pg 15-16
- Parent Letter (English) Pg 17
- Parent Letter (Spanish) Pg 18
- Sharing Information with Medicaid/SCHIP Pg 19
- Free/Reduced Price Meal Family Application (English) Pg 20-21
- Free/Reduced Price Meal Family Application (Spanish) Pg 22-23
- Notice of Approval for Free/Reduced (English) Pg 24
- Notice of Approval for Free/Reduced (Spanish) Pg 25
- Notice of Approval - Direct Certification Pg 26
- Public Release for Free/Reduced Meals/Milk (English) Pg 27
- Public Release for Free/Reduced Meals/Milk (Spanish) Pg 28
- Household Verification Letter Pg 29-30
- Household Verification Results Pg 31
- Income Eligibility Guidelines Pg 32
Non-Discrimination Statement
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.