P-EBT Card and School Fee Waiver
Students must qualify for a free/reduced-price lunch
to receive a P-EBT Card and/or school fee waiver.
Students must qualify for a free/reduced-price lunch to receive a P-EBT Card and/or a school fee waiver. Breakfast and lunch will be offered at no charge, but you must complete a 2021-22 Free and Reduced-Price School Meals Application to determine if you are eligible to receive a P-EBT Card and/or school fee waiver.
Where do I find an application? You can download it from our Food Services website under Food Service, call the office at 937-259-6601 to have one mailed, or click here-https://www.madriverschools.org/cms/lib/OH01914812/Centricity/Domain/41/Application_with_Fee_Waiver_NSLP%202018-19-1.pdf to download a packet.
• Part 1 — List the names of all people living in your home including adults and children.
• Part 2 — If anyone living in your home receives SNAP or OWF, provide the name of that person and the 7-digit case number. If you have a 7-digit case number, skip to Part 5.
If you do not have a 7-digit case number, you may still qualify for school fee waivers
(and/or other programs).
• Part 3 — Check the appropriate box if you are applying for a child who is homeless, migrant, or runaway.
• Part 4 — List all household members with income.
• Part 5 — We must have your permission to share your meal application information to determine if your child(ren) qualifies for a fee waiver. Check “yes” or “no”, sign and date.
— If you check “no”, leave the section blank, or do not sign, your child(ren) may not receive
a school fee waiver.
• Part 6 — The application must be signed and include contact information.
• Part 7 — We are required to ask for information regarding ethnicity. Please check the
appropriate box.
• Double check. Did you provide your signature in Part 5 and Part 6? Are all sections complete?
• Return to your child’s school office or to the Food Services Office.
NOTICE: The Mad River School District does not manage P-EBT information. Please contact the P-EBT helpline at 1-866-244-0071 for questions regarding card activation or address changes.
