Student must qualify for a free/reduced price lunch
to receive a P-EBT Card and/or school fee waiver.
Breakfast and lunch will be offered at no charge, but you must complete the attached 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. Connect to www.payschoolscentral.com/
for an online application. Paper copies will be available at your child’s school or by calling Food Service at 937-859-5121, ext. 1131.
• 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 a 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
• 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 Board of Education Office.