California Department of Education School Nutrition Programs
Nutrition Services Division Sample Letter (REV. 02/2017)
School Year [20XX – XX] [insert school/district name]
Notification Letter for Free or Reduced-Price Meals
[insert date]
Dear Parent or Guardian:
We reviewed your application for free or reduced-price meals for the current school year. Each child identified below is:
Name of Child Name of School
APPROVED for FREE meals.
APPROVED for REDUCED-PRICE meals.
Rates: lunch [insert price], breakfast [insert price], and afterschool snack [insert price]
DENIED for the following reason(s):
Total household income is greater than the allowable amount for free or reduced-price meals.
Your application is incomplete. The following information must be provided: [insert reason]
Other: [insert reason]
If you do not agree or to request a fair hearing to appeal this decision, please contact:
Name: [insert name] Phone Number: [insert phone number]
Address: [insert address]
You may reapply for free or reduced-price benefits at any time during the school year. If you are not eligible now, but your
household income decreases, household size increases, someone in your household becomes unemployed, or your
household qualifies for CalFresh, California Work Opportunity and Responsibility to Kids (CalWORKs), or the Food
Distribution Program on Indian Reservations (FDPIR) benefits, you may submit a new application at that time.
PLEASE NOTE: The child/children listed above may also be eligible to receive assistance for other programs, such as
[insert programs].
To protect the confidentiality of your child, we cannot share the eligibility status with other programs. However, YOU may
share this notification letter by providing a copy to other programs at the school or within your community. Please keep this
letter.
Sincerely,
[insert name]
[insert title]
NON-DISCRIMINATION STATEMENT
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies,
the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are
prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil
rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print,
audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits.
Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service
at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found
online at: [Link] and at any USDA office, or write a letter addressed to USDA
and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-
9992. Submit your completed form or letter to USDA by: (1) Mail: U.S. Department of Agriculture, Office of the Assistant
Secretary for Civil Rights, 1400 Independence Ave SW, Washington, D.C. 20250-9410; (2) Fax: (202) 690-7442; or (3) E-
mail: [Link]@[Link].
This institution is an equal opportunity provider.