Application Form For Free And Reduced-Price School Meals - Oklahoma State Department Of Education Eligibility Documentation Page 4

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SHARING INFORMATION WITH OTHER PROGRAMS
Dear Parent/Guardian:
To save you time and effort, the information you gave on your Application for Free and Reduced-Price
School Meals may be shared with other programs for which your children may qualify. For the following
programs, we must have your permission to share your information. Sending in this form will not change
whether your children get free or reduced-price meals.
Yes! I DO want school officials to share information from my Application for Free and Reduced-
Price School Meals with (Name of Program Specific to Your School) ___________________.
Yes! I DO want school officials to share information from my Application for Free and Reduced-
Price School Meals with (Name of Program Specific to Your School) ______________.
Yes! I DO want school officials to share information from my Application for Free and Reduced-
Price School Meals with (Name of Program Specific to Your School) ______________.
If you checked Yes to any or all of the boxes above, fill out the form below to ensure that your information
is shared for the child(ren) listed below. Your information will be shared only with the programs you
checked.
Child’s Name:
School:
Child’s Name:
School:
Child’s Name:
School:
Child’s Name:
School:
Signature of Parent/Guardian:
Date:
Printed Name:
Address:
For more information, you may call (Name) ___________ at (Phone) ___________ or e-mail at (E-Mail
Address) ______________.
Return this form to: (Address) _______________ by (Date) ____________.
E-64
Oklahoma State Department of Education Eligibility Documentation, July 2012

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