Free/Reduced Lunch Application & Information


PDF format:  2017-2018 Utah Application

or Word: 2017-2018 Utah Appln2



Please be aware that you must apply for free/reduced lunch through the OC website or the OC office for your application to reach the OC, the district registration website will not send us this application.  Thank you.



Dear Parent/Guardian:

Children need healthy meals to learn. Open Classroom Lunch Program offers healthy meals every school day. Lunch costs $3. Your children may qualify for free meals or for reduced price meals. Reduced price is $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.

  1. Who can get free OR REDUCED PRICE meals?
    • All children in households receiving benefits from Utah SNAP, the Food Distribution Program on Indian Reservations (FDPIR) or Utah TANF/FEP, and Medicaid recipients based on income are eligible for free meals.
    • State 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, runaway, or migrant 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.
Household size Yearly$ Monthly$ Weekly$
1 22,311 1860 430
2 30,044 2504 578
3 37,777 3149 727
4 45,510 3793 876
5 53,243 4437 1024
6 60,976 5082 1173
7 68,709 5726 1322
8 76442 6371 1471
Each additional person: 7733 645 149
    1. HOW DO I KNOW IF MY CHILDREN QUALIFY AS homeless, MIGRANT, 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 e-mail Homeless Liaison: Mike Harman 801.578.8140, ext. 2114 – Webpage.
    2. Do I need to fill out an application for each child? No. Use one Free and Reduced Price Meals Application for all children 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: OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected] .
    3. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS 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 OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected] .
    4. CAN I APPLY ONLINE? Yes! You are encouraged to complete an online application instead of a paper application if you are able. The online application has the same requirements and will ask you for the same information as the paper application. Visit (see above)to begin or to learn more about the online application process. Contact OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected] if you have any questions about the online application. You can also get an application in the OC Main Office at any time.
    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 year and for the first few days of this year, through 9.17.17. You must send in a new application unless an official told you that your child is eligible for the new school year. If you do not send in a new application that is approved by the center/school or you have not been notified that your child is eligible for free meals, your child will be charged the full price for meals.
    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.
  • If I don’t qualify now, may I apply later? Yes, you may apply at any time during the current 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.
  • What if I disagree with the school’s decision about my application? You should talk to center/school officials. You also may ask for a hearing by calling or writing to OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected].
  • 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.
  1. What if my income is not always 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.
  2. 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.
  3. 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, 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.
  4. 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. OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected] to receive a second application, or go to to print another application, or get another application from the OC Main Office.
  5. My family needs more help. Are there other programs we might apply for? To find out how to apply for Utah SNAP or other assistance benefits, contact your local assistance office or call Utah SNAP hotline: 1.866.526.3663, or go to .Sincerely, Office Manager, OC Lunch Program
  6. Andrea Winbauer
  7. If you have other questions or need help, call OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected] .



  • Please use these instructions to help you fill out the application for free or reduced price meals. You need to submit an application for all children that attend Open Classroom Charter School, even if your children attend more than one center/school in the SLC school district. We do not receive any applications submitted through the district website. The application must be filled out completely to certify your children for free or reduced price meals. 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 OC Lunch Program, 134 D St SLC 84103; 801.578.8225; or email [email protected].


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, migrant, or runaway youth;

·        Students attending Open Classroom or other school, regardless of age.

A) List each child’s name. Print each child’s name. Use one line of the application for each child. When printing names, write one letter in each box. Stop if you run out of space. 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) Is the child a student? Mark ‘Yes’ or ‘No’ under the column titled “Student” to tell us which children are enrolled in school or child care. If you marked ‘Yes’, write the name of the school or child care center each child is enrolled in. C) Grade level. If you marked ‘Yes,’ and indicated which school or childcare the child attends, write the grade level of the student in the ‘Grade’ column to the right, or check the box under ‘Headstart’ if the child attends a Headstart program. Leave blank if child is younger than 1st grade. D) Do you have any foster children? If any children listed are foster children, mark the “Foster Child” box next to the child’s name.  If you are ONLY applying for foster children, after finishing STEP 1, go to STEP 4.

Foster children who live with you may count as members of your household and should be listed on your application. If you are applying for both foster and non-foster children, go to step 3.

E) Are any children homeless, migrant, or runaway? If you believe any child listed in this section meets this description, mark the “Homeless, Migrant, Runaway” box next to the child’s name and complete all steps of the application.



If anyone in your household (including you) currently participates in one or more of the corresponding assistance programs listed below, your children are eligible for free meals:
·        School/Child Care Center:

o   The Supplemental Nutrition Assistance Program (SNAP)

o   Temporary Assistance for Needy Families (TANF-FEP)

o   The Food Distribution Program on Indian Reservations (FDPIR)
·       Adult Center

o   The Supplemental Nutrition Assistance Program (SNAP)

o   The Food Distribution Program on Indian Reservations (FDPIR)

o   Social Security Income (SSI)

o   Medicaid

·        Family Day Care Home

o   The Supplemental Nutrition Assistance Program (SNAP)

o   Temporary Assistance for Needy Families (TANF-FEP)

o   The Food Distribution Program on Indian Reservations (FDPIR)

o   Medicaid

o   Women, Infants, Children (WIC) Program

A)  Site official prepopulate the program you will be using this application for.

The program selected indicates which programs are eligible for free meals.

B)  Corresponding assistance programs determine eligibility for free meals:

·        The assistance programs listed are determined by the program selected in part A.

·        Circle the assistance program that anyone in the household participates in.

C)  If anyone in your household participates in any of the listed programs:

·        Enter the corresponding case number. You only need to provide one case number. If you participate in one of these programs and do not know your case number, contact or 1-866-435-7414.

·        Go to STEP 4.

How do I report my income?

·        Use the charts titled Sources of Income for AdultsandSources of Income for Children,”  printed on the back side of the application form 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

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 also be counted as a zero. If you write ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials suspect that your household income was reported incorrectly, your application will be investigated.

·        Mark how often each type of income is received using the check boxes to the right of each field.

AReport all income earned or received by children. Report the combined gross income for ALL children listed in STEP 1 in your household in the box marked “Child Income.” Only count foster children’s income if you are applying for them together with the rest of your 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.

Who should I list here?

·        When filling out this section, please include ALL adult members in your household who are living with you and share income and expenses, even if they are not related and even if they do not receive income of their own.

·        Do NOT include:

o   People who live with you but are not supported by your household’s income AND do not contribute income to your household.

o   Infants, Children and students already listed in STEP 1.

B) List adult household members’ names. 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. 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? 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. Report all income that applies in the “Public Assistance/Child Support/Alimony” field on the application. Do not report the cash value of any public assistance benefits NOT listed on the chart. If income is received from child support or alimony, only report court-ordered payments. Informal but regular payments should be reported as “other” income in the next part.
E) Report income from pensions/retirement/all other income. 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 affects your eligibility for free and reduced price meals. G) Provide the last four digits of your Social Security Number. An 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 SSN.”
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, email address, or both is optional, but helps us reach you quickly if we need to contact you. B) Print and sign your name. Print the name of the adult signing the application and that person signs in the box “Signature of adult.” 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.