Dear Parent/Guardian:       

Your child(ren)’s eligibility for Free and Reduced Price School Meals (“F/R Price School Meals”) may entitle him/her to discounts and/or financial support in connection with other programs and services. In order to be considered for such opportunities, we must have your permission to share your child(ren)’s eligibility for F/R Price School Meals with other programs and services, as described below. Sending in this form will not impact whether your child(ren) gets free or reduced price meals.

•    I DO want school officials to share my child(ren)’s eligibility for F/R Price School Meals with the individuals noted below to determine if my child(ren) is eligible to receive financial support for other school activities and services.   PLEASE CHECK  THE PROGRAMS/SERVICES FOR WHICH YOU WOULD WANT TO BE CONSIDERED

•    Fee-based, optional academic testing (i.e. Standard Achievement Test) (SAT Officials)

•  Reduced rate for Summer School or textbooks (School Administrators) 

•  Reduced rate for insurance cost for Laptop Insurance (High School, Middle School, Elementary Administrator)  

•  Reduced rate for graduation fees, yearbook fees, social events (School Administrator/Counselor) 

•  Reduced rate for sports or activities (School Administrator/Athletic Director) 

•  Reduced rate for other services (i.e. school supplies, field/class trips) (School Administrator/Counselor) 

•  I DO NOT want my child(ren)’s eligibility for  Price School Meals shared with any of the above programs or services.    

If you checked any or all of the boxes above indicating your permission to share your student(s)’s eligibility information for F/R Price School Meals, please fill out the below section of this form.  Your information will be shared only with the programs/services 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 Karen Pinardo at 610-645-1990 or e-mail at Pinardk@lmsd.org. Return this form to: Lower Merion Nutritional Services Office, 301 E. Montgomery Avenue, Ardmore, PA  19003.