Consent to Release
Free & Reduced Meal Information
 
 
In accordance with the USDA's National School Lunch Act we must obtain parent permission to release student's meal status information. In order to share your student(s) meal status for the following FREE & DISCOUNT programs, we must have your permission. Completing the form below will not change whether your student(s) will get free or reduced priced meals.

Please place an "X" in the box to indicate which programs YOU DO want Lake County Schools Food Service officials to share your students Free or Reduced meal status with.

English Consent to Share    Consentimiento para compartir
   
It will be the parent's responsibility to provide the Eligibility Approval Letter for Free & Reduced Meals to any other programs that are not listed or consent forms that are not received.

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: 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:

 

mail:     U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights
            1400 Independence Avenue, SW
            Washington, D.C. 20250-9410

fax:     (202) 690-7442; or

email:  program.intake@usda.gov.

 

This institution is an equal opportunity provider.

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