[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-535831-105":59,"doc-detail-535831-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","sample-form-children-categorically-eligible-for-free-meal-benefits-nutrition-department","SAMPLE FORM - Children Categorically Eligible for Free Meal Benefits - Nutrition Department","","Sample certification form for Home-less, Migrant, Head Start, foster care, and related eligible children, instructing local education agencies on how to notify schools and obtain authorized documentation. The memo states that required information was gathered and reviewed, certifying categorically eligible children for free meal benefits under the National School Lunch and School Breakfast programs for a specified school year. Eligibility remains effective through the remainder of the school year and for up to 30 operating days into the next year, unless a new determination is made. Includes a student information table and signature lines.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/sample-form-children-categorically-eligible-for-free-meal-benefits-nutrition-department/535831/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/sample-form-children-categorically-eligible-for-free-meal-benefits-nutrition-department/535831.png","ImageObject",300,407,{"name":92,"@type":93},"Putri","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who must be informed about a student’s status under the form?","Question",{"text":112,"@type":113},"Homeless, runaway, migrant, Head Start, and foster children status is to be communicated by the relevant coordinators or directors to local education agencies and schools.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What does this memo certify?",{"text":117,"@type":113},"It certifies that listed children are categorically eligible for free meal benefits under the National School Lunch and School Breakfast programs for the school year.",{"name":119,"@type":110,"acceptedAnswer":120},"How long does the free meal eligibility remain valid?",{"text":121,"@type":113},"It remains in effect for the remainder of the school year and for a maximum of 30 operating days into the subsequent school year or until a new determination is made, whichever comes first.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},535831,1791671334,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Use your \"Mouse\" or \"Tab\" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click Print button.   \nSAMPLE FORM FOR HOMELESS, MIGRANT, HEAD START COORDINATORS TO NOTIFY LOCAL EDUCATION AGENCIES OR SCHOOLS OF A STUDENT’S STATUS  \n100 North First Street, W-270 Springfield, Illinois 62777-0001  \nNUTRITION DEPARTMENT  \nDATE:    \nTO: Local Education Agency (LEA)  \nFROM:   RE: Children Categorically Eligible for Free Meal Benefits  \nHomeless, runaway, migrant, Head Start and foster children that are under the legal responsibility of a foster care agency or court are categorically eligible for free meal benefits under the National School Lunch and School Breakfast programs. To identify children eligible under these categories, administrators of these programs including migrant education directors (see list at [https://www.niu.edu/illinois-mep/](https://www.niu.edu/illinois-mep/)[ ](https://www.niu.edu/illinois-mep/)[contacts/index.shtml](contacts/index.shtml)), homeless education liaison. If needed, contact your Regional Office of Education (City of Chicago residents may contact the Chicago Public Schools Office of Students in temporary living situations at 773-553-2225), Head Start directors and foster care agency directors are authorized to provide documentation of the migrant, runaway, homeless, Head Start or foster care status of children.  \nThis memo certifies that the required information was gathered and reviewed and it was determined that the children listed below are categorically eligible for free meal benefits under the National School Lunch and School Breakfast programs for the   school year. This documentation is in lieu of Household Eligibility Application for meal benefits. This free meals eligibility remains in effect for the remainder of the school year and for a maximum of 30 operating days into the subsequent school year or until a new determination is made, whichever comes first.  \n\n| FIRST NAME | LAST NAME | BIRTHDATE | GRADE LEVEL | SCHOOL ATTENDING | HOMELESS, RUNAWAY, MIGRANT, HEAD START, OR FOSTER CHILD |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n\nDigital or Original Signature of Migrant Program Director, Date  \nHomeless Liaison, Head Start or Foster Care Agency Director  \nDistrict/Agency:   Address (Street, City, State, ZIP Code):   Telephone (Include Area Code):","cbCaihENFied2pBW","https://ap.wps.com/l/cbCaihENFied2pBW","pdf",400732,"English","# Nutrition Department Certification Memo\n## Eligible Child Status Notification\n## Certification and Duration of Eligibility\n## Student Information Table\n## Authorized Signatures","[{\"question\":\"Who must be informed about a student’s status under the form?\",\"answer\":\"Homeless, runaway, migrant, Head Start, and foster children status is to be communicated by the relevant coordinators or directors to local education agencies and schools.\"},{\"question\":\"What does this memo certify?\",\"answer\":\"It certifies that listed children are categorically eligible for free meal benefits under the National School Lunch and School Breakfast programs for the school year.\"},{\"question\":\"How long does the free meal eligibility remain valid?\",\"answer\":\"It remains in effect for the remainder of the school year and for a maximum of 30 operating days into the subsequent school year or until a new determination is made, whichever comes first.\"}]","SAMPLE FORM - Children Categorically Eligible for Free Meal Benefits - Nutrition Department | PDF",1791601201]