Spirit Lake High School

WAIVER STATEMENT · If your child(ren) qualifies for free or reduced price meals · you may also be eligible for other benefits. If you sign this waiver · your child(ren) will be considered for a full or partial waiver of school fees. I · Signature of Parent/guardian __________________________________________Date _________________

PARENT/GUARDIAN INFORMATION LETTER FOR FREE MILK MEAL APPLICATIONS · Frequently Asked Questions About Free and Reduced Price School Meals · Dear Parent/Guardian: · Children need healthy meals to learn. Spirit Lake School District offers healthy meals every school day. Breakfast costs · $2.45; lunch costs ES $2.95 and MS/HS $3.25. Your children may qualify for free meals/milk or for reduced price meals. · Reduced price is $.30 for breakfast and $.40 for lunch. Please visit our website to complete an application at: https://spirit- · lake.k12.ia.us · 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 the Supplemental Nutrition Assistance Program (SNAP) · the · Family Investment Program (FIP) or a few specific Medicaid programs are eligible for free or reduced price 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 · runaway · or migrant are eligible for free meals. · ● Children may receive free or reduced price meals if your household’s income is at or below the limits on the · Federal Income Eligibility Guidelines below and apply for free and reduced price meals/milk. · FEDERAL INCOME ELIGIBILITY GUIDELINES for SCHOOL YEAR 2025-2026 · Household Size Yearly Monthly Twice per Month Every Two Weeks Weekly · 1 28 · 953 2 · 413 1 · 207 1 · 114 557 · 2 39 · 128 3 · 261 1 · 631 1

5. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No · complete the applications for free and reduced · price school meals for all the students in your household. We cannot approve an application unless complete eligibility · information is submitted · so be sure to complete all required information. · 6. 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 · through 10/10/2025. You · must complete a new application unless the school told you that your child is eligible for the new school year. When the · carryover period ends · unless you are notified that your children will receive free meals or you submit an application · that is approved · the children must pay full price for school meals. The school is not required to send a reminder or a · notice of expired eligibility. · 7. 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 complete and send in an application. · 8. 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. · 9. WILL THE INFORMATION I GIVE BE CHECKED? Yes · we may also ask you to send written proof of the household · income you report. You are not required to provide proof with your application. · 10. 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 or reduced price · meals if the household income drops below the income limit

make substitutions prescribed by the licensed medical professional. If a substitution is needed · there will be no extra · charge for the meal. Please note · however · that the school is not required to make a substitution for a food allergy · unless it meets the definition of disability. Please call the school for further information. · 20. DO I NEED TO REPORT MY RACE AND ETHNICITY? It is optional to complete the racial/ethnic portion of the · application · however · if you do not select race or ethnicity · one will be selected for you based on visual observation. · 21. Translated applications are available at: http://www.fns.usda.gov/school-meals/translated-applications. · If you have other questions or need help · call Jason Olson 2701 Hill Ave · Spirit Lake IA 51360 · 712-336-1370 · [email protected] · Sincerely · Jason Olson -Food Service Director Spirit Lake School District · civil rights regulations and policies · this institution is prohibited from discriminating on the basis of race · color · national origin · sex (including gender identity and sexual orientation) · disability · age · or reprisal or retaliation for prior civil rights activity. · Program information may be made available in languages other than English. Persons with disabilities who require · alternative means of communication to obtain program information (e.g. · Braille

WAIVER STATEMENT · If your child(ren) qualifies for free or reduced price meals · you may also be eligible for other benefits. If you sign this waiver · your child(ren) will be considered for a · made. YOU DO NOT HAVE TO COMPLETE THIS WAIVER TO GET FREE OR REDUCED PRICE SCHOOL MEALS. · Signature of Parent/guardian __________________________________________Date _________________ · Spirit Lake School Nurses are committed to promoting the health and well-being of all students · so that they may achieve academic success and develop lifelong healthy habits! · Student Sick Day Guidelines · Making the right decision: Should I keep my child home or send them to school? · School Policy requires a child to stay home if he/she: · ● Has a fever of 100 degrees or higher · ● Has vomited in the last 24 hours (any questions · contact the nurse) · ● Has had diarrhea in the last 24 hours (any questions · contact the nurse) · ● Has any of the following symptoms that keep them from participating in school: · ○ Very tired or lack of appetite · ○ Coughing or sneezing frequently (this spreads sickness to others) · ○ Headache · body aches · or ear aches · ○ Sore throat (a mild sore throat is okay for school but a severe sore throat may be · a symptom of strep throat even if a fever is not present. Other signs of strep · throat are headaches · stomach aches · or a rash. Please call your healthcare · provider if you child has these symptoms as a special test is needed to diagnose · strep throat) · 24 Hour Rule:

DECLARACIÓN DE RENUNCIA · Si su(s) hijo(s) califica(n) para comidas gratis o a precio reducido · usted también puede ser elegible para otros beneficios. Si firma esta renuncia · su(s) · hijo(s) será(n) considerados para renuncia total o parcial de tarifas escolares. Entiendo que voy a proporcionar información que demostrará que he · las tarifas escolares. Certifico que soy el padre / tutor del (de los) niño(s) para quien(es) se está haciendo la solicitud. · Firma del padre/tutor __________________________________________ Fecha _________________ · USTED NO TIENE QUE COMPLETAR ESTA RENUNCIA PARA OBTENER COMIDAS ESCOLARES GRATUITAS O A PRECIO REDUCIDO. · This institution is an equal opportunity provider.

HOW TO APPLY FOR FREE AND REDUCED PRICE SCHOOL MEALS/MILK · Please use these instructions to help you fill out the application for free or reduced price school meals/milk. You · only need to submit one application per household · even if your children attend more than one school in Spirit · Lake School District. Please follow these instructions in order. Each step of the instructions is the same as the · steps on your application. The application must be filled out completely to certify your children for free or reduced · price school meals. Completed applications should be submitted to Spirit Lake School District · 2701 Hill · Ave · Spirit Lake IA 51360. If at any time you are not sure what to do next · please contact Jason Olson · 712-336-1370 · [email protected]. · STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS · CHILDREN AND STUDENTS UP TO AND · INCLUDING GRADE 12. · PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY. · 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. · A) List each child’s name and date of birth. Print each child’s first name · middle initial · last name and date of · birth (optional). Use one line of the application for each child. If there are more children present than lines on · the application · attach a Supplemental Worksheet · which can be obtained from the school · with all required · Who should I list here? When filling out this section · please include all members in your household who are:

● If ‘YES · ’ provide a case number for SNAP · FIP · or FDPIR. You only need to write one case number. Case · numbers are located on your Notice of Decision. Go to STEP 4. · STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS · Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents. · Gross income is the total income received before taxes. · 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 have known or available information that your household income was · reported incorrectly · your application will be investigated. · A) 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. · B) 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. · C) 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

Report income from public assistance/child support/alimony. Refer to the chart below titled “Sources of · Income for Adults” 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 report court-ordered payments. Informal but regular · payments should be reported as “other” income in the next part. · Report income from pensions/retirement/all other income. Refer to Table 2 below titled “Sources of · Income for Adults” and report all income that applies in the “Pensions/Retirement/All Other Income” field on the · application. · Table 1. Sources of Income for Adults · Earnings from Work Public Assistance/ Alimony/ Pensions/Retirement/All Other · Child Support Income · ● Salary · wages · cash bonuses ● Unemployment benefits ● Social Security (including railroad · ● Net income from self- ● Worker’s compensation retirement and black lung · employment (farm or ● Supplemental Security benefits) · business) Income (SSI) ● Private Pensions or disability · ● Cash assistance from State benefits · or local government ● Regular Income from trusts or · If you are in the U.S. Military: · ● Alimony payments estates · ● Basic pay and cash bonuses · ● Child support payments ● Annuities · (do NOT include combat pay · ● Veteran’s benefits ● Investment Income · FSSA or privatized housing · ● Strike benefits ● Earned interest · allowances) · ● Rental income

Table 2. Sources of Income for Children · Sources of Child Income Example(s) · ● Earnings from work ● A child has a regular full or part-time job where they earn a · salary or wages. (Infrequent earnings · such as income from · occasional babysitting or lawn mowing · are not counted as · income.) · ● Social Security ● A child is blind or disabled and receives Social Security · o Disability Payments benefits. · o Survivor’s Benefits ● A parent is disabled · retired · or deceased · and their child · receives social security benefits. · ● Income from person outside the household ● A friend or extended family member regularly gives a child · spending money. · ● Income from any other source ● A child receives regular income from a private pension fund · annuity · or trust. · 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

1400 Independence Avenue · SW · Washington · DC 20250-9410; or · 2. fax: (833) 256-1665 or (202) 690-7442; or · 3. email: [email protected] · This institution is an equal opportunity provider. · Iowa Non-Discrimination Statement: (revised 7-1-25) It is the policy of this CNP provider not to discriminate on · the basis of race · creed · color · sex · sexual orientation · national origin · disability · age · or religion in its programs · activities · or employment practices as required by the Iowa Code 216.6 · 216.7 · and 216.9. If you have questions · or grievances related to compliance with this policy by this CNP Provider · contact the Iowa Civil Rights · Commission · 6200 Park Ave · Suite 100 · Des Moines · IA 50321; phone number 515-281-4121 or 800-457-4416; · website: https://icrc.iowa.gov/. · Page How to Apply for Free and Reduced Price Meals/Milk

TuTuesday WeWednesday Thursday Friday · Lunch Prices · EVERYDAY! JOIN US TO START · PK-4th $2.95 · YOUR DAY OFF RIGHT!!! Breakfast · 5th-12th $3.25 · Cinnamon Roll · Adult $5.00 · ALL STUDENTS MUST TAKE A Mandarin Oranges · SERVING OF FRUIT OR JUICE · Breakfast Prices · FOR BREAKFAST AND A FRUIT TK/K-12 $2.45 · OR VEGETABLE FOR LUNCH Adult $3.10 · SKIM · CHOCOLATE & 1% MILK Chicken Patty on a Bun · MENU SUBJECT TO CHANGE · Asparagus · 100% FRUIT JUICE AVAILABLE AT Peaches · BREAKFAST MEALS 2nd Choice Sub · 4 6 7 8 · Breakfast Cake Donut Breakfast Breakfast · Biscuit & Gravy · Pineapple · Yogurt Cup Salsa Fruit Cocktail · Apple Grapes · Lunch Lunch · Lunch Cheesy Breadsticks Pizza · Super Nachos · Chicken Nuggets w/ Marinara Sauce Lunch Carrots · Lettuce & Tomatoes

TuTuesday WeWednesday Thursday Friday · BREAKFAST IS SERVED · 2 3 · EVERYDAY! JOIN US TO START 1 · YOUR DAY OFF RIGHT!!! · ALL STUDENTS MUST TAKE A Bagel w/ Cream Cheese · SERVING OF FRUIT OR JUICE Raspberries · FOR BREAKFAST AND A FRUIT · NO SCHOOL NO SCHOOL · OR VEGETABLE FOR LUNCH Lunch · Pepperoni Pizza · SKIM · CHOCOLATE & 1% MILK Lettuce Salad · AVAILABLE AT ALL MEALS Steamed Carrots · Apple · 100% FRUIT JUICE AVAILABLE AT 2nd Choice Sub · BREAKFAST MEALS · 8 10 · 6 7 9 · Cake Donut Breakfast · Biscuit & Gravy Breakfast · Mandarin Oranges French Toast Sticks w/ Syrup · Pineapple Omelet · Fruit Cocktail · Salsa · NO SCHOOL Grapes · Lunch Lunch · Cheesy Breadsticks Cheese Pizza · Super Nachos Lunch · w/ Marinara Sauce Carrots

TuTuesday WeWednesday Thursday Friday · 2 4 · Breakfast Breakfast Cinnamon Roll · Breakfast Sausage Egg & Cheese Sandwich · Pancakes & Sausage Bites Sliced Pears · Pineapples Raspberries · Banana · Lunch Taco Lunch · Lunch Lunch · Chicken Tenders Chicken Patty on a Bun · Broccoli Mashed Potatoes & Gravy · Red Pepper Strips Lettuce Garden Salad · Cherry Tomatoes Asparagus · Apple Refried Beans Steamed Carrots · Fruit Cocktail Peaches · 2nd Choice Sub Strawberries Grapes · 2nd Choice Sub 2nd Choice Sub · 2nd Choice Sub Chocolate Chip Cookie · 2nd Choice Sub · 9 11 13 · 10 12 · Breakfast Cake Donut · Biscuit & Gravy Breakfast · Muffin Mandarin Oranges · Pineapple Omelet · Yogurt Cup · Salsa · Apple · Grapes · Lunch NO SCHOOL