Alternate Household Income Forms & Waivers
We are pleased to inform you that Racine Unified School District will be implementing the Community Eligibility Provision (CEP) while participating in the National School Lunch and School Breakfast Programs for School Year 2020-2021.
What does this mean for you and your children attending any of the following schools:
All students who are enrolled at one of the following locations: Bull Early Education Center, Case, Dr. Jones, Fratt, Giese, Gifford K-8, Gilmore Fine Arts, Horlick, Janes, Jefferson Lighthouse, Jerstad-Agerholm K-8, S.C. Johnson, Julian Thomas, Knapp, Mitchell K-8, RUSD Montessori, North Park, Olympia Brown, Park, Racine Alternate Learning (RAL), The R.E.A.L. School, Red Apple, Roosevelt, Schulte, Starbuck, Wadewitz, Walden III, and West Ridge, are eligible to receive a healthy breakfast and lunch at school at no charge to your household each day of the 2020-2021 school year. Your child(ren) will be able to participate in these meal programs without having to pay a fee or submit a meal application.
The district will still be requesting an Alternate Household Income Form from our families; however, receipt of breakfast and lunch meals at no charge does not depend on the return of this form. Completing the form is necessary to determine eligibility to receive assistance with student fees and other programs. For a complete list of student fees visit www.rusd.org/district/fee-schedule. A Sharing Information with Other Programs form will also need to be completed to waive applicable fees.
You may now complete the Alternate Household Income form and Sharing Information with Other Programs for 2020-21 online
El formulario 20-21 Alternate Household Income y el formulario Sharing Information with Other Programs ahora se pueden completar en línea aquí.
If you have been notified that your children automatically qualify for free or reduced meals via direct certification, please DO NOT submit an online Alternate Household Income form.
Sharing Information with Other Programs - Electronic forms
- 2020-21 Sharing Information with Other Programs - English
- Intercambiando Informacion Con Otros Programas 2020-21 - Spanish
- 2019-20 Sharing Information with Other Programs - English
- Intercambiando Informacion Con Otros Programas 2019-20 - Spanish
- 2018-19 Sharing Information with Other Programs - English
- 2017-18 Sharing Information with Other Programs - English
- 2016-17 Sharing Information with Other Programs - English
Current Year - Printable Forms
- 2020-2021 Alternate Household Income Form - English
- 2020-2021 Alternate Household Income Form - Spanish
- 2020-2021 Sharing Information with Others (Student Fee Waiver) - English
- 2020-2021 Sharing Information with Others (Student Fee Waiver) - Spanish
Previous Year - Sharing Information with Other Program - Printable forms
- 2019-2020 Sharing Information with Others (Student Fee Waiver)
- 2018-2019 Sharing Information with Others (Student Fee Waiver)
- 2017-2018 Sharing Information with Others (Student Fee Waiver)
- 2016-2017 Sharing Information with Others (Student Fee Waiver)
Completed paper forms can be photographed and emailed to email@example.com or delivered to the Finance/Food Service office at the Administrative Service Center. Mail completed forms to:
Racine Unified School District
Attn: Finance/Food Service
3109 Mount Pleasant Street
Racine, WI 53404
USDA Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442; or
(3) email: firstname.lastname@example.org.
This institution is an equal opportunity provider.