Antioch Unified School District

Please use these instructions to help you fill out the School Funding Form for SUN Bucks.

You only need to submit one application per household, even if your children attend more than one school in the Antioch Unified School District.  The application must be filled out completely to determine the eligibility of your child(ren) for SUN Bucks. Please follow these instructions in order. Each step of the instructions is the same as the steps on your application.  If at any time you are not sure what to do next, please contact Antioch Unified School District, Nutrition Services Office, 701 West 18th Street, Antioch, CA 94509 or by phone at (925)-779-7300, option 2.

Please use a pen (not a pencil) when filling out the paper application and do your best to print clearly. Alternatively, you may complete the form online by visiting www.myschoolapps.com.

STEP 1: List ALL students up to and including grade 12
Tell us how many elementary/middle/high school students live in your household. They do NOT have to be related to you to be a part of your household.
Who should I list here? When filling out this section, please include ALL members in your household who are:

• Students (regardless of age) enrolled in Antioch Unified School District AND are supported with the household’s income;

• In your care under a formal foster arrangement through a court or state/local agency, or qualify as homeless or migrant youth.

A.  List each child’s name and Student ID (if known).
Print each child’s name. Use one line of the application for each child. If there are more children present than lines on the application, attach a second piece of paper with all required information for the additional children. This also applies to adults in Step 3. “MI” is short for middle initial. Print the first letter of each child’s middle name in the box.

B.  Date of Birth.
Print each child’s date of birth. Student Income.
List all income earned or received by students. List the gross income for each student in your household. Only count foster children’s income if you are applying for them together with the rest of your household.

• What is Student Income? Student income is money received from outside your household that is paid DIRECTLY to your children. Many households do not have any child income.

C.  Do you have any foster children?
If any children listed are foster children, mark the “Foster Child” box next to the child’s name.
Foster children who live with you may count as members of your household and should be listed on your application.
Note: Adopted children are not considered foster children. A foster child is a minor child who has been taken into state custody and placed with a state-licensed adult, who cares for the child in place of their parent or guardian.

D. Are any children homeless or migrant?
If you believe any child listed in this section meets this description, mark the “Homeless, Migrant, Runaway” box next to the child’s name and complete all steps of the application. Homeless, Migrant, Runaway status must be confirmed with the appropriate program staff. If the school district cannot confirm your student’s homeless, migrant, or runaway status, then the school district will contact you to complete an income-based application. You may choose to provide income information now in order to prevent the school district from potentially needing to contact you later.

Step 2: Do any household members currently participate in CalFresh (Supplemental Nutrition Assistance Program [SNAP]), CalWORKs (TANF), or FDPIR?
If anyone in your household (including you) currently participates in one or more of the assistance programs listed below, your children are eligible for SUN Bucks:

• The Supplemental Nutrition Program (SNAP) or CalFresh.

• Temporary Assistance for Needy Families (TANF) or CalWORKs.

• The Food Distribution Program on Indian Reservations (FDPIR).

A.  If no one in your household participates in any of the above listed programs:

• Skip Step 2 and go to Step 3.

B.  If anyone in your household participates in any of the above listed programs:

• Write a case number for SNAP, TANF, or FDPIR. You only need to provide one case number. If you participate in one of these programs and do not know your case number, contact your local county health and human services office.

Go to Step 3.

Step 3: List ALL household members not already reported in student section. How do I report my income?

• Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents.

  • Gross income is the total income received before taxes and deductions.

  • Many people think of income as the amount they “take home” and not the total, “gross” amount. Make sure that the income you report on this application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay.

• Write a “0” in any fields where there is no income to report. Any income fields left blank or empty will also be counted as a zero. If you write “0” or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials suspect that your household income was reported incorrectly, your application will be investigated.

Mark how often each type of income is received using the check boxes to the right of each field.

A.  Report Income earned by adults.  Who should I list here?
Print the name of each household member in the appropriate boxes. Include college students, unless they are declared independently on taxes (all college students are considered adults). Do not list any household members you listed in Step 1.

• Do NOT include:

  • People who live with you but are not supported by your household’s income AND do not contribute to the income of your household.

  • Students already listed in Step 1.

B.  List adult household members’ names.
Print the name of each household member in the appropriate boxes. Include college students, unless they are declared independently on taxes (all college students are considered adults). Do not list any household members you listed in Step 1.

C.  List earnings from work.
List all income from work in the “Earnings from Work” field on the application. This is usually the money received from working at jobs. If you are a self-employed business or farm owner, you will report your net income. Net income is your income after taxes and deductions have been subtracted.

• What if I have multiple jobs? List each job separately by entering your name and income from each job on a new line. Add an additional sheet of paper if necessary.

• What if I am self-employed? List income from your business as a net amount. This net amount is calculated by subtracting the total operating expenses of your business from its gross receipts (revenue). Gross receipts or revenue are all the income earned from the sale of any products or services offered.

If a student listed in Step 1 has income, follow the instructions in Step 1, Part D.

D.  List income from public assistance/child support/alimony.
List all income that applies in the “Public Assistance/Child Support/Alimony” field on the application. Do not report the cash value of any public assistance benefits NOT listed on the chart. If income is received from child support or alimony, only report court-ordered payments. Informal but regular payments should be reported as “other” income in the next part.

E.  List income from pensions/retirement/all other income.
List all income that applies in the “Pensions/Retirement/All Other Income” field on the application.

• What if I receive income from multiple sources in this category? List each source separately by entering your name and income from each source on a new line. Add an additional piece of paper if necessary.

F. List total household size.
Enter the total number of household members in the field “Total Household Members (Children and Adults).” This number MUST be equal to the number of household members listed in Step 1 and Step 3. If there are any members of your household that you have not listed on the application, go back and add them. It is very important to list all household members, as the size of your household affects your eligibility for SUN Bucks.

Step 4: Contact information and adult signature

All applications must be signed by an adult member of the household. By signing the application, that household member is promising that all information has been truthfully and completely reported. Before completing this section, please also make sure you have read the statements on this application.

DISQUALIFICATION PENALTIES: Individuals found to have committed an intentional Program violation either through an administrative disqualification hearing or by a Federal, State or local court, or who have signed either a waiver of right to an administrative disqualification hearing or a disqualification consent agreement in cases referred for prosecution, shall be ineligible to participate in the Program:

• For a period of twelve months for the first intentional Program violation, except as provided under paragraphs (b)(2), (b)(3), (b)(4), and (b)(5) of this section;

• For a period of twenty-four months upon the second occasion of any intentional Program violation, except as provided in paragraphs (b)(2), (b)(3), (b)(4), and (b)(5) of this section; and

Permanently for the third occasion of any intentional Program violation.

A.  Provide your contact information.
Write your current mailing address in the fields provided, if this information is available. If you have no permanent address, that is okay. Sharing a phone number, email address, or both is optional, but helps us reach you quickly if we need to contact you.

B.  Print and sign your name and write today’s date.
Print the name of the adult signing the application. That person signs in the box “Adult Household Member Signature”.

C.  Mail completed application to Antioch Unified School District, Nutrition Services Office, 510 G Street, Antioch, CA 94509

Optional

Share children’s racial and ethnic identities (optional). On this application, we ask you to share information about your child’s race and ethnicity. This field is optional and does not affect your children’s eligibility for SUN Bucks. This information is requested solely for the purpose of determining the State’s compliance with Federal civil rights laws, and your response will not affect consideration of your application, and may be protected by the Privacy act. By providing this information, you will assist us in assuring that this program is administered in a nondiscriminatory manner.

Please return the application directly to your child’s SCHOOL or in person to the Nutrition Services Office (701 West 18th Street, Antioch). DO NOT mail, fax, or email completed applications or questions about applications to the California Department of Education or the USDA Office of the Assistant Secretary for Civil Rights or your child’s eligibility for SUN Bucks will be delayed.

If you intend to move, or have recently moved, you should apply for benefits in the State where your child(ren) will complete or completed the school year immediately preceding the summer operational period.