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National School Lunch Program Application Materials

All forms have been changed. Last year's documents will not be accepted.

Forms that must be returned to the State Office
2019-2020 National School Lunch Program Attachments
PERMANENT AGREEMENT - Must be completed by all SFAs Agreement Word document
NSLP Application Checklist Checklist Acrobat Reader
NSLP Timeline 2019-2020 Timeline Acrobat Reader
Free and Reduced-Price Policy Statement Policy Statement Word document
Attachment A - National School Lunch Program Attestation Form Attachment A Word document
Attachment B - Parent Letter for Free and Reduced Price Family Meals Application for Lunch and Breakfast Attachment B Word document
Attachment B-1 - Free and Reduced Price Family Meals Application for Lunch and Breakfast Attachment
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Attachment B-2 - Free and Reduced Family Meals Application Instructions Attachment B-2 Word document
Attachment C - Parent Letter and Special Milk Application (If applicable) Attachment C Word document
Attachment C-1 - Special Milk Application (if applicable) Attachment
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Attachment C-2 Special Milk Program Application/Instructions Attachment C-2 Word document
Attachment D - After School Snack Program Application (If applicable) Attachment D Word document
Attachment E - State of NH Federal Meals Program Wellness Documentation Attachment E Word document
Attachment F - Ethnic/Racial Data Form (completed by RCCI's and Non-Public Schools only) Attachment F Word document
Attachment G - List of Board Members (completed by RCCI's and Non-Public Schools only) Attachment G Word document
Attachment H - Procurement and Food Service Management Compancy Declaration Issue Attachment H Word document
Attachment J - Computerized System for Verifying Nutrient Analysis Attachment J Word document
Attachment K - NSLP Paid Lunch Equity (PLE) Attestation Attachment K Word document

Attachment K-1 -NSLP Paid Lunch Equity (PLE) Tool - (completed excel worksheets) used to calculate Paid Lunch prices [New]

Attachment L - Procurement Procedures Declaration Page Attachment L Word document
Attachment T - Non Program Food Revenue Calculator Tool (completed excel worksheets) used to complete non-program food revenue [New] Attachment T Excel
Attachment T-1 - Non Program Food Revenue Reference Period Attestation [New] Attachment
Word document
Attachment U - At-Risk Afterschool Supper Meals Application [Revised] Attachment U Word document
Attachment V - Computerized System for Meal Benefit Approval Attachment V Word document
Parent Appeal Rights Parent Appeal Word document
Attachment W - Financial Information (NEW) Attachment W Excel
Forms for School Food Authority Use
Attachment M - Notification of Eligibility Determination Attachment M Word document
Attachment N - Sharing of Information with Other Programs Attachment N Word document
Attachment O - Free and Reduced Price Family Meals Family Application/Eligibility Disclosure Requirement Programs (In-House Document for SAU's) Attachment O Word document
Attachment P - Determining Official Income Guidelines Attachment P Acrobat Reader
Attachment R - Administrative Appeal Procedures Attachment R Acrobat Reader
Attachment S - Notice of Direct Certification Attachment S Word document

Income Guidelines Rates for Reimbursement

FY 2019
(07/01/18 - 06/30/19)

FY 2020
(07/01/19 - 6/30/20)

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(07/01/18 - 06/30/19)

FY 2020
(07/01/19 - 06/30/20)

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Microsoft Excel Symbol Microsoft Excel format. You can download a free reader from Microsoft.

Acrobat Reader Symbol Acrobat Reader format. You can download a free reader from Adobe.

Microsoft Word Symbol Microsoft Word format. You can download a free reader from Microsoft.

New Hampshire Department of Education
101 Pleasant Street | Concord, NH | 03301-3494
Telephone: (603) 271-3494 | TDD Access: Relay NH 711