• Click below to open the application form:

     
     
     
    Please note that a new application form must be submitted each year - forms from the 2017-18 year are only valid through October 17, 2018.  If your child was approved for free or reduced price meals last year and you do not file a new application form with the District before October 17th, you will be responsible for the full cost of your child's meals beginning on October 18th.
     
    Form Instructions:
     
    Please print out the form, and complete it.  * You only need to complete one form for your entire family - just make sure you list all of your children that attend school on the top section of the form.  In the second section, list ALL of your household members (even children that do not yet attend school).  List all income for each household member, and make sure to specify how often the income is received (weekly, monthly, yearly, etc.).  *If you don't specify how often it is received, we are required to count the income as weekly income in making our determination of your application's eligibility.  If you receive Food Stamps, Temporary Assistance for Needy Families (TANF) or have a Food Distribution Program on Indian Reservation (FDPIR) case number, enter it in the space provided.  *Please make sure you use the CASE number - not the number from a benefit card, etc.  If you list a case number for one of these programs, you are not required to list your income.  
     
    When you are done listing everything (household members and income amounts or Food Stamp, TANF or FDPIR case numbers), please enter the last four digits of your Social Security Number in the space provided, sign and date the form.  *We cannot process your form without your Social Security Number and signature on it. Return your completed form to:
     
    Mrs. Suzanne Kowal, Business Office Secretary
    Lake Shore Central Schools
    959 Beach Road
    Angola, New York 14006