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Sharing Information with Other Programs

Required

Dear Parent/Guardian:

Based on the information you gave on your Education Benefits Form, your child may qualify for other programs. For the following
programs, we must have your permission to share your information. Sending in this form will not change whether your children get free
or reduced-price meals.
 
Yes! I DO want school officials to share information from my Education Benefits Form with:
Multiple Choicerequired
If you check “Yes” to any or all of the boxes above, please fill out form below. Your information will be shared only with the programs you
checked.
Please provide the full name of your child. (Must contain only letters and spaces)
Select school location.
Please provide the full name of your child. (Must contain only letters and spaces)
Select school location.
Please provide the full name of your child. (Must contain only letters and spaces)
Select school location.
Please provide the full name of your child. (Must contain only letters and spaces)
Select school location.

 

Please fill in your full name. (Must contain only letters and spaces)
Enter your email address.
Enter your home/mailing address.
Type full name for signature.
Please select date. (Must contain a date in M/D/YYYY format)
For more information, you may call Mrs. F. Covington at 313.833.1100 ext. 1189.