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Get the Prototype Media Release for Free and Reduced-Price Meals

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This document outlines the policy for free and reduced-price meals, eligibility guidelines, application instructions, and related information for households regarding their children's meal benefits
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How to fill out Prototype Media Release for Free and Reduced-Price Meals

01
Obtain the Prototype Media Release form from your school or district's website.
02
Read the instructions provided on the form carefully.
03
Fill out the student's name, school, and grade level in the designated sections.
04
Provide the parent's or guardian's name and contact information.
05
Specify the desired media type (photographs, video recordings, etc.) by checking the appropriate boxes.
06
Indicate whether you grant permission for the student's likeness to be used for promotional purposes.
07
Sign and date the form at the bottom to validate the release.
08
Submit the completed form to the school office or appropriate contact as instructed.

Who needs Prototype Media Release for Free and Reduced-Price Meals?

01
Students participating in free and reduced-price meal programs.
02
Schools needing consent to use student images for promotional purposes.
03
Parents or guardians who want to provide or deny media consent for their children.
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In California, that would mean that a family of four must have a total income of at most $39,000 for the children to qualify for free school meals and at most $55,500 to qualify for reduced-price meals in the current school year.
CalFresh Income Limits and Maximum Benefits for 10/1/2024 - 9/30/2025 Household SizeGross Monthly Income LimitMaximum Monthly Benefit 1 $2,510 $292 2 $3,408 $536 3 $4,304 $768 4 $5,200 $9755 more rows
Frequently Asked Questions Household SizeGross monthly income (130 percent of poverty)Net monthly income (100 percent of poverty) 1 $1,632 $1,255 2 $2,215 $1,704 3 $2,798 $2,152 4 $3,380 $2,6005 more rows • Aug 29, 2025

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The Prototype Media Release for Free and Reduced-Price Meals is a standardized document used by schools and organizations to inform the public about the availability of free and reduced-price meals provided under the National School Lunch Program and the School Breakfast Program.
Schools, school districts, and food service operators that participate in the National School Lunch Program or School Breakfast Program are required to file the Prototype Media Release.
To fill out the Prototype Media Release, organizations should include the program's details, eligible meal options, application instructions for families, income eligibility guidelines, and any important dates related to meal service.
The purpose of the Prototype Media Release is to ensure that families are aware of the meal programs available to them and encourage participation among eligible students in order to provide essential nutrition.
The information that must be reported includes program availability, eligibility criteria, application procedures, contact information for inquiries, and any supporting documentation regarding the meal programs.
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