Programs & Services - Fuel Up! School Lunch Program - Subsidy - Subsidy Application Form

Programs & Services - Fuel Up! School Lunch Program - Subsidy - Subsidy Application Form

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Student Information

Legal last name: *

Legal first name: *

School: *

Additional Student(s) Information

Legal last name:

Legal first name:

School:

Legal last name:

Legal first name:

School:

Legal last name:

Legal first name:

School:

Parent Information

Parent/legal guardian (lives with student): *

Contact Email: *Please give the email address that the Fuel Up Coordinator should contact to confirm arrangements.

Telephone: *

Subsidy Information

I am seeking a lunch subsidy for: *

Financial Reasons (see below)A special circumstance (see below)

Please briefly describe your reasons for applying for the Fuel Up! subsidy: *

To assist in providing as many healthy meals as possible, please pay what you can. Some families will require a full subsidy, where meals will be provided at no cost to the families, and some families will be able to pay a partial fee with a partial subsidy. Do you require a partial subsidy or a full subsidy?

Subsidy Level: *

I require a PARTIAL subsidyI require a FULL subsidy

If you are seeking a partial subsidy, please select the amount that YOU are able to pay:

Duration - I expect that I will need this subsidy until (approximate date): *

Agreement

I have read and understand: *

the program informationevery effort will be made to provide allergen free meals, however, common food allergens are used in our caterer's kitchen and cross contamination is always a possibility.that if my child(ren) has severe allergies, I should pack a meal from home instead of using the school lunch program.

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