Attachment 50

                                                                                                 Sample Parent Letter

INSERT YOUR AGENCY LETTERHEAD

 

The ___________________________________________ (Name of Sponsoring Organization) is participating in the Summer Food Service Program. Meals will be provided to all eligible children free of charge.  (To be eligible to receive free meals at a camp, children must meet the income guidelines for reduced price meals in the National School Lunch Program). Children who are part of households that receive foods stamps or benefits under the Food Distribution Program on Indian Reservations (FDPIR), or Temporary Assistance to Needy Families (TANF) are automatically eligible to receive free meals. The following 2015-2016 income eligibility standards will be used for determining eligibility for free meals:

 

                                                        Income Eligibility Guidelines

Household Size                      Year                        Month                   Twice                      Every                      Weekly                                                                                   per Month              Two Weeks

1                      $21,978                       $1,832             $   916             $   846             $   423

2                      $29,637           $2,470             $1,235             $1,140             $   570

3                      $37,296           $3,108             $1,554             $1,435             $   718

4                      $44,955           $3,747             $1,874             $1,730             $   865

5                      $52,614           $4,385             $2,193             $2,024             $1,012

6                      $60,273           $5,023             $2,512             $2,319             $1,160

7                      $67,951           $5,663             $2,832             $2,614             $1,307

8                      $75,647           $6,304             $3,152             $2,910             $1,455

For each additional

family member, add                   $  7,696           $   642             $  321              $   296             $   148

 

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.

 

 Eligibility has been established for the site(s) listed. No further documentation is required.

 

 Please fill out and return an “Application for Free and Reduced Price School Meals/Milk.”

 

Persons interested in receiving more information should contact:

(Name, Address and Phone Number of Sponsor)

 

 

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, 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 Avenue, SW

Washington, D.C. 20250-9410;

 

(2)           fax: (202) 690-7442; or

 

(3)           email: program.intake@usda.gov.

 

This institution is an equal opportunity provider.

 

(Signature of Authorized Representative)                                                      (Date)

 

 

(Enter camp and/or closed enrolled site(s) information)

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

 

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times

 

Site Name
Site Address
Begin Date	End Date	Meals Available	Service Times