Adams County Community Assistance Programs

 
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 Adams County Community Assistance Programs 
Dear Parent/Guardian:

To save you time and effort, the information you gave on your Free and Reduced Price School Meals Application 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.

YOU WILL NOT BE ELIGIBLE FOR THE FOLLOWING PROGRAMS UNLESS THIS FORM IS COMPLETED AND SIGNED. THIS FORM MUST BE COMPLETED FOR EACH HOUSEHOLD.


 
1.
*
Please check the box next to any/all of the programs you wish to request to share your information with.
 
  
  
  
   
2.
 
   
Child 1:  
Child 2:  
Child 3:  
Child 4:  
Child 5:  
   
3.
*
 

 

 

 
   
4.
 
   
  For more information, you may contact our North Adams Community Schools Food and Nutrition Department at 260-724-7121 ext. 2185.



"This institution is an equal opportunity provider."
   
 
 
 
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