West Branch Comm School District

as supported by USDA and the State of Iowa · you may also qualify for Instructional fees to be waived or reduced. This benefit must be applied for · it is not an automatic benefit if you qualify for free or reduced meals. To apply for a waiver of Instructional fees · creed · color · sex · sexual orientation · gender identity · national origin · disability · age · or religion in its programs · activities · or employment practices as required by the Iowa Code section 216.6 · 216.7 · and 216.9. If you have questions or grievances related to compliance with this policy by this CNP Provider · please contact the Iowa Civil Rights Commission · Grimes State Office Building · 400 E 14th St · Des Moines · State or local agencies · and their subrecipients · this institution is prohibited from discriminating on the basis of race · color · national origin · sex (including gender identity and sexual orientation) · disability · age · Braille · large print

26 West Branch K-12th BREAKFAST · STUDENT BREAKFAST IS $1.85 · All Breakfast served with Orange Juice and choice of · Each meal must have a fruit and 2 other items. · 1% White · Skim White & Chocolate Skim Milk · We reserve the right to change the menu without notice

26 West Branch K-8th MENU · Student Must have a Fruit or Vegetable and 2 other Daily Fruit and Vegetable bar for 3rd-8th Grade! · components. Milk offered daily: 1% White · Skim White · Skim · Pre Order Chef Salads available 5th-8th Grade Chocolate. We reserve the right to change the menu

26 West Branch High School MENU · Student Must have a Fruit or Vegetable and 2 other Daily Fruit and Vegetable bar · components. Milk offered daily: 1% White · Skim White · Skim · Pre Order Chef Salads available Chocolate. We reserve the right to change the menu

2023

2025 · Revision Date: May 8 · 2023 · Legal Reference: 42 U.S.C. §§ 1751 et seq. · 7 C.F.R. §§ 210 et seq. · U.S. Dep’t of Agric. · SP 46-2016 · Unpaid Meal Charges: Local Meal Charge · Policies (2016). · U.S. Dep’t of Agric. · SP 47-2016 · Unpaid Meal Charges: Clarification on · Collection of Delinquent Meal Payments (2016). · U.S. Dep’t of Agric. · SP 57-2016 · Unpaid Meal Charges: Guidance and Q&A · (2016). · Iowa Code 283A. · 281 I.A.C. 58. · Cross Reference: 701 Nutrition Program · 701.03 Free or Reduced Cost Meals Eligibility · 701.04 Vending Machine · Page 2 of 2 · Public Release for Schools Operating the National School Lunch and Breakfast Program · The Iowa Department of Education · Bureau of Nutrition and Health Services · has finalized its policy for free and · reduced price meals for students unable to pay the full price of meals served under the National School Lunch · Program · School Breakfast Program

​ ​ 1 · Page · meals and the school will not send a reminder or a notice of expired eligibility. An application cannot be approved · unless complete eligibility information is submitted. Applications may be submitted at any time during the year. If a · family member becomes unemployed the family should contact the school to complete an application. · Households notified of their student’s eligibility must contact the school if the household chooses to decline the · free meal benefits. · Foster children are eligible for free meal benefits. Some foster students will be qualified for free meals · automatically through the state direct certification process. Their host family will receive notification of these · benefits. Families that receive this notification from the school need to do nothing more for their foster students to · receive free meals. If a family has foster students living with them and does not receive notification and wishes to · apply for such meals · instructions for making application for such students are contained on the application form. · A foster student may be included as a member of the foster family if the foster family chooses to also apply for · benefits for other students. Including students in foster care as household members may help other students in · the household qualify for benefits. If the foster family is not eligible for free or reduced price meal benefits · it does · not prevent a foster student from receiving benefits. Special Supplement Nutrition Program for Women · Infants · and Children (WIC) participants may be eligible for free or reduced price meals based on a completed application. · When known by the school · households will be notified of any child eligible for free meals if the children are · enrolled in the Head Start/Even Start program or are considered homeless · migrant or runaway. If any children · are not listed on the notice of eligibility · contact the school for assistance in receiving benefits. If households are · dissatisfied with the application approval done by the officials · they may make a formal appeal either orally or in · writing to the school’s designated hearing official. The policy statement on file at the school contains an outline of · the hearing procedure. School officials may verify the information in the application

​ ​ 2 · Page · AD-3027 OMB Control Number: 0508-0002 · Expiration Date: 05/31/2024 · U.S. Department of Agriculture · Complainant Information · First name Middle Initial Last Name · Mailing Address · Primary Phone Number Alternate Phone Number Email · Best way to reach you: □Mail □Phone □Email □Other · Representative Information · Do you have written authorization from representative? · Do you have a representative? □Yes □No · If so · please attach. □Yes □No · First name Last Name · Mailing address · Phone Email · Complaint Information · (attach additional pages and supporting documentation as needed) · 1. Provide the name of the program you applied for (if known/applicable). · 2. Select the USDA agency that conducts the program or provides Federal financial assistance for the program. · □ FNS □ FS □ FSA □RD □ · NRCS □ · Other □ · Unknown · 3. Date of recent alleged discrimination 4. Location and/or address of the office where discrimination occurred · (mm/dd/yyyy) · 5. Who do you believe discriminated against you? Include the name(s) of person(s) involved in the alleged discrimination (if known). · 6. What happened to you? (please include dates of each allegation)

PARENT/GUARDIAN INFORMATION LETTER FOR FREE AND REDUCED PRICE SCHOOL MEAL · APPLICATION · Frequently Asked Questions About Free and Reduced Price School Meals · Dear Parent/Guardian: · Children need healthy meals to learn. West Branch Community Schools offers healthy meals every school day. Breakfast · costs $1.85; lunch costs $2.95 (EK-8) and $3.10 (9-12). Your children may qualify for free meals/milk or for reduced price · meals. Reduced price is $.30 for breakfast and $.40 for lunch. Return or mail the completed application to: West Branch · Community Schools · attn: Central Office · 225 N. Maple St. · West Branch · IA 52358. · 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 submit an application 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

4. 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. · 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 school year and for the first few days of this school year · October 7 · 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. · 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 complete and send in an application. · 7. 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. · 8. 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. · 9. 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

may be eligible for Hawki (children’s health insurance) or a waiver of school fees. Read the information on the back of · the Application for Hawki information. A school waiver form is available from your school. · 18. CAN CHILDREN WITH DISABILITIES GET FOOD SUBSTITUTIONS? If a child has a disability · as determined by a · licensed medical professional · and the disability prevents the child from eating the regular school meal · the school will · 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. · 19. DO I NEED TO REPORT MY RACE AND ETHNICITY? It is optional to complete the racial/ethnic portion of the · application. · 20. Translated applications are available at: http://www.fns.usda.gov/school-meals/translated-applications. · If you have other questions or need help · call 319-643-7213 or email [email protected]. · Sincerely · Laura Góngora · 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.

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 West · Branch Community 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 mailed or returned to West Branch · Community Schools · 225 N. Maple St. · West Branch · Iowa 52358. If at any time you are not sure what to do · next · please contact Laura Góngora; 319-643-7213 or [email protected]. · PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY. · STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS · CHILDREN AND STUDENTS UP TO · AND INCLUDING GRADE 12. · 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 West Branch Community Schools · regardless of age. · A) List each child’s name and date of birth. Print each child’s first name · middle initial · last name and date of

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. · Mark · A) Report how · total often eachsize. · household type Enter · of income is received · the total numberusing the check · of household boxes tointhe · members theright · fieldof“Total · eachHousehold · field. · 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.

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/ Pensions/Retirement/All Other · Alimony/Child Support Income · ● Salary · wages · cash bonuses ● Unemployment benefits ● Social Security (including · ● Net income from self- ● Worker’s compensation railroad retirement and black · employment (farm or ● Supplemental Security lung 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 · ● Allowances for off-base ● Regular cash payments from · housing · food and clothing outside household

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 and write today’s date. Print the name of the adult signing the application and · sign in the box labeled “Signature of adult completing the form.” · C) Mail or return completed form to: West Branch Community Schools 225 N. Maple St. West Branch · IA · 52358. Please do not mail completed form to the Department of Agriculture as this will delay · processing. · D) Decline having your information released to Hawki. If you do not want your household information shared · with Hawki · print · sign and date in the box provided. · E) Obtaining translated applications. If you need a translated application with instructions · they can be found in · 49 languages at: https://www.fns.usda.gov/school-meals/translated-applications. · Agriculture (USDA) 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

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 INSTRUCTIONAL fees. I understand that I will be releasing information that · will show that I applied for free and reduced price school meals for my child(ren). I give up · my rights to confidentiality for waiver of school instructional fees ONLY. I certify that I am · the parent/guardian of the child(ren) for whom application is being made. · YOU DO NOT HAVE TO COMPLETE THIS WAIVER TO GET FREE OR REDUCED PRICE SCHOOL MEALS. · Signature of Parent/Guardian Date · Name of Student Grade · Name of Student Grade · Name of Student Grade · Name of Student Grade · Name of Student Grade · Name of Student Grade · AUXILIARY SERVICES — Series 700 · 701 Nutrition Program · 701.05 Meal Charges · In accordance with state and federal law · the West Branch Community School District adopts the · following policy to ensure school district employees · families · and students have a shared · understanding of expectations regarding meal charges. The policy seeks to allow students to · receive the nutrition they need to stay focused during the school day · prevent the overt · identification of students with insufficient funds to pay for school meals · and maintain the

TUESDAY WEDNESDAY THURSDAY FRIDAY · Waffle Mini French Toast · Assorted Cereal/Bar 45 · Assorted Cereal/Bar 45 · Fruit Fruit School · Orange Juice 14 or Apple · Juice15 · Orange Juice 14 or Apple · Juice15 · Enjoy! · 1 2 3 · Funfetti Pancakes Sausage on a Bagel Whole Cinn. French Toast Circle Donut · No Or Or Or Or · Assorted Cereal/Bar 45 Assorted Cereal/Bar 45 · School Assorted Cereal/Bar 45 · Fruit Fruit · Assorted Cereal/Bar 45 · Fruit Fruit · Enjoy!! Orange Juice 14 or Apple Orange Juice 14 or Apple Orange Juice 14 or Apple Orange Juice 14 or Apple · 6 Juice15 7 Juice15 8 Juice15 9 Juice15 10 · Maple Snacking Waffles Sausage Pancake Stick Egg & Cheese on a Roll Mini French Toast Donut Holes · Or Or Or Or Or · Fruit Fruit Fruit Fruit Fruit · 13 Juice15 · 14 Juice15 15 Juice15 16 Juice15 17 · Omelet w/ Roll Whole Pancakes Ham on a Biscuit French Toast Sticks Long John · Or Or Or Or Or · Fruit Fruit Fruit Fruit Fruit · Blueberry Snacking Waffles Choc. Chip Pancakes Egg & Cheese on a Roll Mini French Toast · Or Or Or Or

TUESDAY WEDNESDAY THURSDAY FRIDAY · Corn Dog Carnitas16 Tacos15.33 · Pears19 Tropical Mixed Fruit No · Fresh Fruit · Grape Tomatoes · Fresh Fruit School · Shredded Lettuce2 · Carrots · ALT.-Mac n Cheese Refried Beans Enjoy! · 1 2 · ALT.-Chicken Teriyaki w/ Rice 3 · Mr. Rib on WG Bun36 Crispito Hamburger on Bun 28 · Chicken Strip Wrap · No Mixed Fruit Pears19 Mand. Oranges13 · Shredded Lettuce Applesauce · Fresh Fruit · School Fresh Fruit · Baked Beans30 · Carrots6 Fresh Fruit · Tator Tots · Cucumbers3 Alt.- Beef Teriyaki Dippers15 · Enjoy!! Romaine Salad2 Roasted Chickpeas · w/1oz roll Broccoli · 6 ALT.Mini Corn Dogs 7 ALT.-Meatball Sub 8 9 ALT-Pork Chop 10 · Bosco Sticks28 · Corn Dog Taco on WG Shell Chicken Patty on Bun · Ham and Cheese Wrap Pears19 Peaches · Cranberries27 Mixed Fruit Pineapple · Fresh Fruit Fresh Fruit Diced Tomato Fresh Fruit · Fresh Fruit Cherry Tomatoes

TUESDAY WEDNESDAY THURSDAY FRIDAY · Corn Dog Carnitas16 Tacos15.33 · Pears19 · Fresh Fruit · Tropical Mixed Fruit No · Fresh Fruit School · Grape Tomatoes · Carrots Shredded Lettuce2 · ALT.-Mac n Cheese w/ 1oz Roll Refried Beans Enjoy! · 1 2 · ALT.-Chicken Teriyaki w/ Rice 3 · Chicken Strip Wrap Mr. Rib on WG Bun36 Crispito Hamburger on Bun 28 · No Mixed Fruit · Pears19 Mand. Oranges13 Applesauce · Fresh Fruit · School Fresh Fruit Baked Beans30 · Shredded Lettuce Fresh Fruit · Cucumbers3 Carrots6 Tator Tots · Enjoy!! Romaine Salad2 · Roasted Chickpeas · Alt.- Beef Teriyaki Dippers15 Broccoli · 6 ALT.Mini Corn Dogs 7 ALT.-Meatball Sub 8 w/2oz roll 9 ALT-Pork Chop 10 · Cranberries27 Mixed Fruit Pears19 Pineapple Peaches · Fresh Fruit Fresh Fruit Fresh Fruit Diced Tomato Fresh Fruit · Cauliflower2.6 w/ Cheese Romaine Salad Cherry Tomatoes Refried Beans Corn · Broccoli3 · Sweet Potato Fries Carrots Shredded Lettuce Cucumbers · ALT.-Chicken Strips w/ 1oz ALT.-Mac n Cheese w/ 1oz Roll ALT.-Mandarin Chicken w/ · Goldfish 13 14 · ALT.-Cheddar Bratwurst on Bun 15 Rice 16 ALT. Hotdog on Bun 17

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