Income Eligibility Forms 2015-2016

If you wish to apply or reapply for Tier 1 (Higher) reimbursement, please fill out and return the appropriate form.  Contact the 4-C CACFP office with any questions.

See the list below for current tier 1 eligible schools.

Eligible School List

Provider Household Income Form

Provider Household Income Application
Use this form if you wish to apply for tier 1 reimbursement based on your own household income.

School or Census Application

School/Census Application
Use this form if you wish to apply for tier 1 reimbursement based on your school or census area.

Parent/Guardian Household Income Eligibility

Parent/Guardian Application
Distribute this form to all families in your care.

Tier Option Request

Tier Option Request Form

Back