Permission for Student Info Share
Dear Parent(s)/Guardians(s):

To save you time and effort, the information you gave on your Free and Reduced Price School Meals Application may be shared with other programs for which your children may quality. For the following programs, we must have your permission to share your information and receive various benefits.

Sending in this form will not change whether your children get free or reduced price meals.

For more information, you may call Sally Cowden at 724-796-1551 ex 2391 or scowden@fortcherry.org

Mrs. Sally Cowden
Food Service Clerk
Parents/Guardians' Name *
Your answer
Family's Home Address *
Your answer
Child/ren's Name(s) & Grade(s) (list all children attending FCSD) *
Your answer
I WILL ALLOW the Fort Cherry Food Service Department to share my child/childrens' free and reduced lunch information with other Fort Cherry School Officials to enable my family benefits from the following programs. (information will NOT be shared with anyone outside the School District). Check all programs you would like to obtain free/reduced fees and/or assitance:
I DO NOT allow Fort Cherry Food Service Department to share my child/childrens' information with other Fort Cherry District Officials. I understand I will not benefit from free/reduced fees or assistance services through the Fort Cherry School District programs. (Type your name on line as a legal signature.)
Your answer
I verify the information provided in this form has been completed by the parent listed at the top fo this form. (Type name on line as legal signature.) *
Your answer
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