Permission to Share Information with Other Programs
Dear Parent(s)/Guardians(s):

To save you time and effort, the information you gave on your Free/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 to receive various benefits.

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

For more information, you may call Sally Cowden at 724-796-1551 ex 2391 or

Mrs. Sally Cowden
Food Service Clerk
Parents/Guardians' Name *
Children's Name(s) & Grade(s) (list all children attending FCSD) *
I WILL ALLOW the Fort Cherry Food Service Department to share my children's free/reduced meal information (children's name & status) with other Fort Cherry School Officials/Programs 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 assistance:
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.) *
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