Paper Free/Reduced Meal Application Request

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Once received, please send the completed application in the pre-paid self addressed return envelope. Please call 503.916.3402 or email mealbenefits@pps.net with any questions.

I have a student(s) that attends (or will attend) Portland Public Schools *

Yes

My student(s) attends (or will attend) the following school(s) - please provide the school name(s) *

Student name (First Name & Last Name) *

Parent/Guardian name (First Name & Last Name) *

Street Address (example, 501 N Dixon St) *

City (example, Portland) *

State (example, OR) *

Zip Code (example, 97227) *

Your email address or phone number (in case there are questions about your request) *

Please acknowledge the following: *

Please Read and Check

I understand that approved meal benefits expire at the end of each school year.

If eligible for benefits, I understand that a new meal application must be submitted each school year.

If approved, I understand each student is eligible for one complete breakfast and one complete lunch per school day.

I understand that a la carte milk purchased by itself or in addition to the milk that comes with the meal is a charge of $.50 each.

Please Read and Check

I understand that approved meal benefits expire at the end of each school year.

If eligible for benefits, I understand that a new meal application must be submitted each school year.

If approved, I understand each student is eligible for one complete breakfast and one complete lunch per school day.

I understand that a la carte milk purchased by itself or in addition to the milk that comes with the meal is a charge of $.50 each.

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