Lunch Money – Application | A Little More Support

Main Contact

Main Contact Name *

First

Last

Relationship to Applicant *

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

The Applicant

The applicant is the individual who will be receiving the actual benefit (e.g. your child)

Applicant Name *

First

Last

Social Security Number *

Birthdate *

Foster Child *

Yes
No

Homeless/Migrant/Runaway *

Racial and Ethnicity *

Applicant School/Food Supplier

School/Food Supplier Name *

School District (enter 'NA' if Food Supplier) *

School/Food Supplier Address *

Address Line 1

City

State

Zip Code

School/Food Supplier Contact *

School/Food Supplier Phone *

Applicant School ID (enter 'NA' if Food Supplier)

Current Grade (select 'NA' if Food Supplier) *

Current Enrollment

Does any member of the Household currently participate in the following programs? (check all that applies)

If any of the above box is checked, specify who in the Household is receiving these benefits

Financial Info

If the applicant is receiving any income, please list in detail the source, the amount, and frequency

Household Income

Household is defined as a group of related or unrelated individuals who are not residents of an institution or boarding house, but who are living as one economic unit sharing housing and all significant income & expenditures

Adult 1

Name

First

Last

Relationship to Applicant

Social Security Number

Employer

Employer Address

Address Line 1

City

State

Zip Code

Employer Phone

Total annual income from this employer

How often this employer issues a pay check?

If there are additional employers, please list separately the Employer Name, Address, Phone, Income, and frequency of pay check

Income from Public Assistance / Child Support / Alimony

How often Public Assistance / Child Support/ Alimony is received?

Income from Pensions / Retirement, and all other income

How often Pensions / Retirement, and all other income is received?

Adult 2

Name

First

Last

Relationship to Applicant

Social Security Number

Employer

Employer Address

Address Line 1

City

State

Zip Code

Employer Phone

Total annual income from this employer

How often this employer issues a pay check?

If there are additional employers, please list separately the Employer Name, Address, Phone, Income, and frequency of pay check

Income from Public Assistance / Child Support / Alimony

How often Public Assistance / Child Support/ Alimony is received?

Income from Pensions / Retirement, and all other income

How often Pensions / Retirement, and all other income is received?

Additional Adult

If there are additional adults in the household who have incomes, please list them separately in details

File Upload

Please include the following with the application:-
Income tax return for the most current year for each of the individuals (or combined household) listed in the 'Financial Information' section. (Please label the file name clearly)

Tax Return: Applicant