SAMPLE NOTIFICATION LETTER - DIRECT CERTIFICATION - Request to Opt Out of Free Meals

Oct 10, 2026

Sample notification letter for direct certification approving identified students for free school meals for the current school year. The letter explains approval is based on household eligibility tied to SNAP, TANF, income-eligible Medicaid, or foster child status. It instructs parents not to complete a household eligibility application for listed students and provides steps to opt out if the family does not want meal benefits. It also includes guidance to contact the school for questions, plus federal civil rights and non-discrimination notice details, including how to request alternative communication and file a discrimination complaint with USDA.

LanguageEnglish

CategoryHealthcare

FormatDOC

Pages1

Reading Time3 min

AccessFree to download

Direct certification and free meal approval

Opt-out instructions for parents

Contact information and corrections

Civil rights notice and how to file a complaint

SAMPLE NOTIFICATION LETTER - DIRECT CERTIFICATION Date: ______________________ Dear Parent/Guardian: Each student identified below is automatically approved for free school meals for the current school year based on your eligibility for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF), Income Eligible Medicaid or Foster Child status. Name of Student Grade Assistance Source School Name Please do not fill out a Household Eligibility Application for free or reduced price meals for the students listed above. This student(s) will receive free meals unless you notify us that you do not want to receive these benefits. If you do not want your child to receive free meal benefits please completely fill out the information in the box below and return to the school office no later than ___________________. (Insert Date) If you have student(s) in your household who are not listed above, please contact this office at the telephone number provided below at your earliest convenience. A Household Eligibility Application is NOT needed; free meal benefits will be extended to all children residing in the same household except foster child status is for the foster child only. I do not want my child(ren), as listed above, to receive free meal benefits. _________________________ ____________________________________________ Date Signature of Parent or Guardian If any of the information listed above is incorrect, or you have any questions, please contact this office at (_____) _______________. Name Title In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: HYPERLINK "https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf" https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: mail:U.S. Department of AgricultureOffice of the Assistant Secretary for Civil Rights1400 Independence Avenue, SWWashington, D.C. 20250-9410; or fax:(833) 256-1665 or (202) 690-7442; or email: HYPERLINK "http://mailto:program.intake@usda.gov/" program.intake@usda.gov This institution is an equal opportunity provider.

FAQs

How are students approved for free school meals under direct certification?

Approval is automatic based on the parent/guardian’s eligibility for SNAP, TANF, income-eligible Medicaid, or foster child status.

Do parents need to submit a household eligibility application for the listed students?

No. The letter states a household eligibility application is not needed for students listed above.

What should parents do if they do not want their child to receive free meal benefits?

They must completely fill out the information in the box below and return it to the school office by the stated deadline.

How can a civil rights discrimination complaint be filed?

A complainant should complete Form AD-3027 or submit a letter with required contact and incident details to USDA using mail, fax, or email options provided in the letter.

Oct 10, 2026

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