2011 application & instructions - hawaii child nutrition...

F R E E A N D R E D U C E D P R I C E S C H O O L M E A L S A P P L I C A T I O N A N D V E R I F I C A T I O N F O R M S

SCHOOL YEAR _____-_____

INSTRUCTIONS FOR SCHOOL DISTRICTS

This packet contains prototype forms:

Required information that must be provided to households: Letter to Households Free and Reduced Price School Meals Application Notice to Households of Approval/Denial of Benefits1 (notification is required if household is denied)

Required information for households selected for verification of eligibility information materials: Notification of Selection for Verification of Eligibility Letter of Verification Results

Optional application-related materials that may be provided to households: Sharing Information with Medicaid/SCHIP Sharing Information with Other Programs Notice to Households of Approval/Denial of Benefits1 (notification is optional if household is approved) Notice of Direct Certification

The pages are designed to be printed on 8½” by 11” paper. Some pages may be printed front and back. You will need to identify the benefits that are offered in your school, such as afterschool snacks. The [bold, bracketed fields] indicate where you need to insert school district specific information. For example, you must include your district’s no-charge telephone number for verification assistance on the verification materials. If these materials have not been modified to include your State’s name for the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, Temporary Assistance to Needy Families (TANF), State Children’s Health Insurance Program (SCHIP), or, if applicable, to add Food Distribution Program on Indian Reservations (FDPIR), you should insert this information as appropriate. This prototype application package includes information regarding the exclusion of housing allowance for those in the Military Housing Privatization Initiative. If this is not pertinent to your school district, please modify as appropriate. Your State agency may require you to submit your application package for approval. If you have questions, contact:

[State agency address]

1All households must be notified of their eligibility status. Households with children who are denied benefits must be given written notification of the denial. The notification must advise the household of the reason for the denial of benefits, the right to appeal, instruction on how to appeal, and a statement that the family may re-apply for free and reduced price meal benefits at any time during the school year. Households with children who are approved for free or reduced price benefits may be notified in writing or orally.

Free and Reduced Price School Meals ApplicationInstructions for School Districts of 1July 2011 - Language

Chuukese

[ I N S ER T S C H O OL DI S T R I C T L ET T E RH EA D ]

Achengicheng Saam me Inn/Chóón tumwun:

Semiriit repwe mongo mongon epwe apechokuner ar repwe kaéé. [Name of School] a awora mongo mi apechokuna iteitan ranin sukuun. Niwinin mongon nesossor [$];niwinin mongon neanowas [$]. Noum kewe semiriit ra tongeni aninis ren an esapw kamé aner mongo ika fen kekisinó niwinin aner mongo. Niwinin mongo mi kekisino ukukun [$] ren mongon nesossor iwe [$] ren mongon neanowas.

1. UPWE AMASOWA EW APINIKEISON REN EMON ME EMON NEI KEWE SEMIRIIT? Aapw. Amasowa ewe apinikeison om kopwe tungor an esapw kamé ika kekisinón niwinin mongo. Sise tongeni etiwa ew apinikeison ika ese wes amasowan, ina pwata kopwe amasowanong meinisin ekkewe pworaus mi mak pwe kopwe amasowanong. Eniwini ewe apinikeison a amasow ngeni: [name, address, phone].

2. IO A TONGENI ANGEI EKKEI MONGO ESE KAMÉ? Meinisin semiriit non ekkewe iimw ra angei aninis seni [State SNAP], [the Food Distribution Program on Indian Reservations] ika [State TANF], a tongeni wor aner mongo ese kamé esapw anongonong won ar moni tonong. Noumw kewe semiriit ra pwan tongeni angei aner mongo ese kamé ika pwe kapachenapen moni tongon non ewe iim mi nomw non ewe aukuk mi affat non an mwuun Merika we Annukun Tufichin Aninis Anongonon won Moni Tonong.

3. MI TUFICH AN EKKEWE SEMIRIIT RA NOMW FAN NEMENIEN MWUUN REPWE MONGO NGE ESAPW KAMÉ? Ewer, ekkewe semiriit ra nomw fan nemenien mwuun mi chiwen nomw non annuk pwe wisen ewe ofes a kan tumunu ekkei semiriit ika kapwung, ra tufich ar repwe mongo esapw kamé. Io we semiriit a nomw fan tumwunuan mwuun non ewe iim a tongeni mongo ekkewe mongo ese kamé esapw pwan anongonong won moni tonong.

4. MI TUFICH AN EKKEWE SEMIRIIT ESE WOR IMWER, EKKEWE RA SU SENI IMWER, ME EKKEWE IR CHON EW FÉNU REPWE TONGENI MONGO ESAPW KAMÉ? Ewer, semiriit ekkewe iir mi nomw non wewen nge esor imwer, ekkewe ra su seni imwer, ika ekkewe chóón ew fénu ra tufich aninis ren mongo ese kamé. Ika pwe ese mo wor a erenuk pwe noum kewe repwe angai aner kewe mongo esapw kamé, kose mochen kékké ika e-mail [school, homeless liaison or migrant coordinator information] omw kopwe sine ika ir mi tufichin angei ei pwekin aninis.

5. IO A TONGENI EPWE KEKISINÓ NIWIN ANAN MONGO? Noumw kewe semiriit ra tongeni angei aner epwe kukkun niwinin ika pwe an chóón ewe iimw moni tonong a nomw non ewe aukuukun niwin a affat non ewe chepenin moni tonong a tufichi aninis a nomw won ei taropwe apininkeison.

6. UPWE PWAN CHIWEN AMASOWA ECHÉ APINIKEISON IKA PWE MI TORIEI ECHÉ TAROPWEN SENI EI SUKUUN A ERA PWE NEI KEWE SEMIRIIT RA KETIW REN ANINISIN MONGO AN ESAPW? Kose mochen aneani fichi ewe taropwe ka angei me fiti met e era kopwe fééri. Kékkéri ewe sukuun won [phone number] ika mi wor omw kapas eis.

7. NOUN NEI WE APINIKEISON A FEN KETIW NON EWE IER A NÓ. UPWE PWAN CHIWEN AMASOWA PWAN ECHÉ? Ewer. Noun noumw we apinikeison a chok ééchu ngeni non ena ierin sukuun me ekkóóch ranin ei ierin sukuun. Kopwe tinanong eché minaféén apinikeisin chilon chok ika ewe sukuun epwe erenuk pwe noum we ese tufichin aninis non ei ierin sukuun.

8. NGANG MI NOUNOU WIC. NEI WE MI TONGENI ANGEI ANAN MONGO ESAPW KAMÉ? Semiriit non ekkewe iimw ir mi nounou WIC ra tongeni tufich ngeni ekkewe mongo ese kamé ika mi kekis niwinin. Kose mochen amasowa Kose mochen amasowa eché apinikeison.

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Taropwe ngeni chóón ewe iimwPeich 1/ 2July 2011 – Chuukese

9. EKKEWE PWORAUS UWA AWORA KOPWE PWAN CHEKI? Ewer sa pwan tongeni tungoreok om kopwe tinato taropwe anetatá.

10. IKA PWE USE TUFICHIN ANINIS, NGANG MI PWAN TONGENI TUNGOR MWIRIN? Ewer, ka tongeni tungor (apply) ese nifinifin fansoun nge non chok ena ierin sukuun. Awewe, semiriit ekkewe iner me semer ika chóón tumunur rese chiwen angang ra tongeni tufich ngei ei aninisin mongo an esapw kamé ika epwe kekis niwinin ika pwe moni tonong non ewe iimw epwe turutiw fan ewe éukukun moni tonong.

11. NGEF IKA USE TIPEEW NGENI AN EWE SUKUUN FINATÁ IKA KAPUNG FAN ITEN NEI WE APINIKEISON? Kopwe pworaus ngeni ekkewe chóón angangen ewe sukuun. Ka pwan tongeni tungor ew arongorong ka tongeni kékk’e ika mmak ngeni: [name, address, phone number, e-mail].

12. NGANG MI TONGENI TUNGOR (APPLY) IKA EMON CHÓÓN NON IMWEI WE ESAPW EMON CHÓÓN MERIKA? Ewer. En ika noum we(kewe) ouse pwan need oupwe chóón Merika ren ami oupwe tufich ngeni ekkei aninisin mongo ese kamé me mi kekis niwinin.

13. IO IPWE TONGENI APACHANONG PWE CHÓÓN NON IMWEI WE? Kopwe apachanong meinisn aramas ir mi nomw non imwomw we, aramasom ika esapw (pachenong mama me papa chi, ekkóóch aramasom, ika chiechiom) ekkewe ouwa eaea fengen moni tongon me moni ka kamé won. Kopwe apachonong pwisin en me meinisin ekkewe semiriit ra nomw remw. Ika ke nomw ren ekkóóch ekkewe mi pwisin wor ar moni tonong, (awewe, aramas kese anisiir, ouse pwan nounou fengen moni me noum kewe semiriit, me ra mééni wiser ewe mi affat), kosapw pwan apacherenong.

14. NGE IKA AI MONI TONGON ESE NÉNNÉNÓ ITEITAN FANSOUN MEINISIN? Makkeitiw ukukun met ka kan angei. Awewe, ika ke kan angei $1000 non ew maram, nge ke etiwanó ekkóóch ranin angang non ewe maram a no nge ka chok angei $900, makkeitiw pwe ka kan angei $1000 non ew maram. Ika ekan soun napenó noumw awa seni aukukun awan angang (overtime), apachanong, nge kosapw apachanong ika ke kan chok overtime fan ekkóóch. Ika a pout sonuk omw we angang ika a fen kekisinó noum awa ika niwinum, iwe kopwe chok eaea omw we moni tonong iei.

15. AM MI NOMW NON SOUNFIU. AUPWE PWAN A PACHANONG NOUM MONIAN IIMW PWE AM MONI TONONG? Ika en mi angei monian omw kopwe nomw nukun ewe nenien sounfiu, epwe pwan kapachenong pwe omw moni tonong. Nge, ika pwe imwomw seni ewe kinikinin aninisin iimw ngeni, kosapw apachanong monian imwomw we pwe ew moni tonong.

16. IKA PUNUWEI WE A TITINÓ NGENI NENIEN MAUN. NIWININ NE MAUN EPWE PWAN ANEA PWE EW MONI TONONG? Apw, ika pwe niwinin we ne maun a angei fengen me niwinin pwokiten an we titinó ngeni maun me ese angei me mwen an we titinó ngeni maun, niwinin we ne maun esapw anea pwe ew moni tonong. Kééri omw we sukuun ren pwan ekkóóch pworaus.

17. AI EI FAMINI MI MOCHEN PWAN EKKÓÓCH ANINIS. MI WOR PWAN EKKÓÓCH PROKRAM AUPWE TONGEI TUNGOR (APPLY)? Omw kopwe sine ifa usun kopwe tungor ewe [State SNAP] ika pwan ekkóóch aninis, kééri ewe ofes non neniomw we kééri [State hotline number].

Ika mi wor ekkóóch pwan ami kapas eis ika ke mochen aninis, kééri [phone number].

Si necesita ayuda, por favor llame al teléfono: [phone number].

Si vous voudriez d’aide, contactez nous au numero: [phone number].

Sincerely,

[signature]

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Taropwe ngeni chóón ewe iimwPeich 2/ 2July 2011 – Chuukese

I F A US U N O M W K OP W E T U N G O R ( A P P L Y )

CHÓÓN NON EWE IIMW A PACHENONG SEMIRIIT IKA MI WATTE RA NOMW REMWA.

IKA CHÓÓN NON IMWOMW WE IR MI ANGEI AR ANINIS SENI [STATE SNAP], IKA [STATE TANF] [OR THE FOOD DISTRIBUTION PROGRAM ON INDIAN RESERVATIONS (FDPIR)] , FITI EKKEI:Kinikin 1: Etetenatiw meinisin chóón non iimw me itan ewe sukuun emon me emon ekkewe semiriit a fiti. Kinikin 2: Etetenatiw nampan an emon me emon ekkewe chóchón non ewe iimw (kapachenong mi watte) keis ekkewe ra nounou ekkewe aninis ren [State SNAP] ika [State TANF] ika [FDPIR].Kinikin 3: Amwmwet seni ei kinikin.Kinikin 4: Amwmwet seni ei kinikin.Kinikin 5: Saini ei taropwe. Ekkewe ruanu násinóón nampan noum we soson sikiuriti kosapw pwan awora.Kinikin 6: Kopwe pwisin finata omw pénueni ei kapas eis.

IKA ESE WOR EMON ME NON IMWOMW WE A NOUNOU/EAEA [State SNAP] IKA [State TANF] ANINIS ME IKA EMON SEMIRIIT NON IMWOMW WE ESE WOR IMWAN, II CHÓÓN EW FÉNU IKA E SU SENI IMWAN, KOPWE FITI EKKEI MI TETENITIW:Kinikin 1: Etetenatiw meinsin chóón non imwomw kewe me iten ewe sukuun an emon me emon ekkewe semiriit.Kinikin 2: Amwmwet seni ei kinikin.Kinikin 3: Ika pwe emon ekkewe semiriit ka tungor fan itan esor imwan, a feito seni ew fénu, ika su seni imwan cheki ewe pwór ren ewe a weneiti me kékkéri [your school, homeless liaison, migrant coordinator]. Kinikin 4: Awesano ne amasowa chok ika ewe semiriit non imwomw we ese tufichin aninis fan nurun Kinikin 3. Nengeni pworausan met kopwe fééri ren meinisin chóón non ewe iimw. Kinikin 5: Saini ewe taropwe. Ekkewe nássin nampan sooson sekiuriti kese pwan awora ika pwe kosapw amasowa Kinikin 4. Kinikin 6: Kopwe pwisin finata omw pénueni ei kapas eis.

IKA KOPWE TUNGOR ANINIS FAN ITAN EMON SEMIRIIT A NOMW FAN NEMENIEN MWUUN, FÉÉRI EKKEI METTÓÓCH A AFFAT FAN:Ika meinisin semiriit non ewe iimw ir semiriit mi nomw fan nemenien mwuun: Kinikin 1: Etetenatiw meinisin semiriit mi nomw fan nemenien mwuun me itan ewe sukuun an emon me emon ekkewe semiriit. Cheki ewe pwór omw kopwe affata ika ewe semiriit ii emon semiriit mi nomw fan nemenien mwuun. Kinikin 2: Amwmwet seni ei kinikin.Part 3: Amwmwet seni ei kinikin.Part 4: Amwmwet seni ei kinikin.Part 5: Saini ei taropwe. Ekkewe ruanu násinóón nampan noum we soson sikiuriti kosapw pwan awora.Part 6 Kopwe pwisin finata omw pénueni ei kapas eis.

Ika ekkóóch ekkei semiriit non ewe iimw ir semiriit mi nomw fan nemenien mwuun: Kinikin 1: Etetenatiw meinsin chóón ewe iim me itan an emon me emon semiriit sukuun. Ren ese nifinifin aramas, pachenong semiriit, ese wor ar moni tonong, kopwe cheki ewe pwór a mak “No Income”. Cheki ewe pwór ika ewe semiriit emon mi nomw fan nemenien mwuun. Kinikin 2: Ika pwe imwomw we ese wor nampan an keis, amwmwet seni ei kinikin. Kinikin 3: Ika pwe emon ekkewe semiriit ka tungor aninis fan itan ese wor imwan, ii a feito seni ew fénu, ika e su seni imwan ka cheki ewe pwór a weneiti ika kééri [your school, homeless liaison, migrant coordinator]. Ika aapw, amwmwet seni ei kinikin.Kinikin 4: Fiti met ei taropwe a era ren omw kopwe repotuni kapachanapen moni tonong seni ei maram ika ewe maram a nó.

Pwór 1–Itan: Etetenatiw meinisin chóón non ewe iimw fengen me ar moni tonong. Pwór 2 –Ukukun moni tonong mwen takesis me fan fite ka angei: Ren emon me emon chóón non ewe iimw,

etetenatiw ew me ew sokkun moni tonong a angei non ew maram. Kopwe ereni kich fan fite ka angei ewe moni—iteitan wiik, iteitan mwirin ruu wiik, fan ruu non ew maram ika non ew maram. Ren niwin, kopwe makkeitiw moni

Free and Reduced Price School Meals ApplicationInstructions for ApplyingPage 1 of 2July 2011 - Language

tonong mwen takesis, esapw niwinum we ka uwanó neimw. Gross income iei ewe aukukun ka angei mwen epwe tou takesis me pwan ekkóóch met epwe katou me non niwinum. Ka tongeni kun ei me won risiten niwinum we ika noum we pwos a tongeni erenuk. Ren pwan ekkóóch moni tonong, makkei me etetenatiw ukukun met emon me emon aramas mi angei seni wenfer, aninisin semiriit (child support), moni emon mi pupunu epwe méni ngeni ewe emon fansoun ra mwu fesen mi affat me non kapwung (alimony), moni ka angei fansoun ka ritaer seni omw angang ewe a kawor seni omw angang (pensions), monien ritaer, sooson sekiuriti, Supplemental Security Income (SSI), aninis seni pekin sounfiu (VA benefits), ika aninisin mi ter. Fan Meinisin Pwan Pekin Moni Tonong (all other income), makkeitiw aninisin chóón angang ika repwe feiengaw non angang, aninisin ekkewe ese chiwen wor ar angang (unemployment) ika aninisin fansoun an chóón angang kounó ne angang (strike), aninis seni aramas rese nomw non imwomw we me pwan ekkóóch moni. Kosapw apachanong moni tonong seni SNAP, FDPIR, WIC, aninisin sukuun seni mwuun Merika ika niwin tumwunun ekkewe semiriit mei nomw fan nemenien mwuun ekkewe famini ra angei seni ekkewe ofes ra anenia (ekkei semiriit). Ren CHOK ekkewe ra pwisin anganga ar pisinis, fan ewe Earnings from Work, repwotuni moni tonong mwirin moni kopwe kamé won. Iei fan itan omw we pisinis, atake, ika iimwen rent. Ika en mi nomw non Military Privatized Housing Initiative ika peiof seni pekin maun, kosapw apachanong ekkei moni non omw we moni tonong.

Kinikin 5: Ekkewe chóón non ewe iimw mi watte repwe saini ei taropwe me makkeitiw ekkewe ruanu nampan nesopun nour kewe sooson (ika makkei ewe pwór ika ese wor neun) Kinikin 6: Kopwe pwisin finata omw pénueni ei kapas eis.

MEINISIN PWAN EKKEWE CHÓÓN NON EWE IIMW, PACHENONG EKKEWE RA NOUNOU WIC, FITI/FÉÉRI EKKEI MI TETENITIW:Kinikin 1: Makkei/etetenatiw meinsin chóón ewe iimw me itan ewe sukuun an emon me emon ekkewe semiriit. Ren ese nifinifin aramas, kapachenong semiriit, ese wor ar moni tonong, kopwe cheki ewe pwór “No Income”. Kinikin 2: Ika ese wor nampan an chóón ewe iimw keis, amwmwet seni ei kinikin. Part 3: Ika emon nein ekkewe semiriit ka tungor aninis fan itan ese wor imwan, ii a feito seni pwan ew fénu, ika a su seni imwan cheki ewe pwór a weneiti me kééri [your school, homeless liaison, migrant coordinator]. Ika esapw, amwmwet seni ei kinikin.Kinikin 4: fiti/fééri met ekkei a affat fan omw kopwe repwotuni kapachanapen moni tonong an chóón non ewe iimw non ei

maram ika ewe maram a nó. Pwór 1–Iit Makkeitiw meinsin chóón ewe iimw mi wor ar moni tonong. Pwór 2 – Ukukun moni tonong mwen takesis me fan fite ka angei: Ren emon me emon chóón non ewe iimw,

etetenatiw ew me ew sokkun moni tonong a angei non ew maram. Kopwe ereni kich fan fite ka angei ewe moni—iteitan wiik, iteitan mwirin ruu wiik, fan ruu non ew maram ika non ew maram. Ren niwin, kopwe makkeitiw moni tonong mwen takesis, esapw niwinum we ka uwanó neimw. Gross income iei ewe aukukun ka angei mwen epwe tou takesis me pwan ekkóóch met epwe katou me non niwinum. Ka tongeni kun ei me won risiten niwinum we ika noum we pwos a tongeni erenuk. Ren pwan ekkóóch moni tonong, makkei me etetenatiw ukukun met emon me emon aramas mi angei seni wenfer, aninisin semiriit (child support), moni emon mi pupunu epwe méni ngeni ewe emon fansoun ra mwu fesen mi affat me non kapwung (alimony), moni ka angei fansoun ka ritaer seni omw angang ewe a kawor seni omw angang (pensions), monien ritaer, sooson sekiuriti, Supplemental Security Income (SSI), aninis seni pekin sounfiu (VA benefits), ika aninisin mi ter. Fan Meinisin Pwan Pekin Moni Tonong (all other income), makkeitiw aninisin chóón angang ika repwe feiengaw non angang, aninisin ekkewe ese chiwen wor ar angang (unemployment) ika aninisin fansoun an chóón angang kounó ne angang (strike), aninis seni aramas rese nomw non imwomw we me pwan ekkóóch moni. Kosapw apachanong moni tonong seni SNAP, FDPIR, WIC, aninisin sukuun seni mwuun Merika ika niwin tumwunun ekkewe semiriit mei nomw fan nemenien mwuun ekkewe famini ra angei seni ekkewe ofes ra anenia (ekkei semiriit). Ren CHOK ekkewe ra pwisin anganga ar pisinis, fan ewe Earnings from Work, repwotuni moni tonong mwirin moni kopwe kamé won. Iei fan itan omw we pisinis, atake, ika iimwen rent. Ika en mi nomw non Military Privatized Housing Initiative ika peiof seni pekin maun, kosapw apachanong ekkei moni non omw we moni tonong.

Kinikin 5: Ekkewe chóón non ewe iimw mi watte repwe saini ei taropwe me makkeitiw ekkewe ruanu nampan nesopun nour kewe sooson (ika makkei ewe pwór ika ese wor neun) Kinikin 6: Kopwe pwisin finata omw pénueni ei kapas eis.

Free and Reduced Price School Meals ApplicationInstructions for ApplyingPage 2 of 2July 2011 - Language

APINIKEISONUN MONGON SUKUUN AN ESAPW KAMÉ IKA EPWE KEKISINÓ NIWININ

KINIKIN 1. MEINISIN CHÓÓN NON EWE IIMW

Itan meinisin chóón ewe iimw(First, Middle Initial, Last)

Itan ewe sukuun an emon me emon semiriit ika makkei “NA” ika ewe semiriit ese nomw non sukuun

Cheki ika ewe semiriit ( tumwunun nge wisan ewe ofesin wenfer ika kapwung)

* Ika meinsin ekkewe semiriit ir mi nomw fan nemenien mwuun, amwmwet seni Kinikin 5 ka saini ei taropwe.

Cheki ika ESOR moni tonong

KINIKIN 2. ANINIS

IKA MI WOR NEIN CHÓÓN NON IMWOMW WE A NOUNOU [State SNAP], [FDPIR] IKA [State TANF Cash Assistance], AWORA NAMPAN EWE KEIS AN EWE A KAN NOUNOU EKKEI PEKIN ANINIS ME AMWMWET SENI KINIKIN 5. IKA ESE WOR MI NOUNOU/EAEA EKKEI ANINIS, AMWMWET SENI KINIKIN 3.

ITOMW:____________________________________________________________________ NAMPAN KEIS: __________________________________________________________

KINIKIN 3. IKA EMON SEMIRIIT KA TUNGOR ANINIS FAN ITAN ESE WOR IMWAN, II A FEITO SENI EW FÉNU ME NUKUN, IKA A SU SENI IMWAN KA CHEKI EWE PWÓR A WENEITI IKA KÉÉRI [your school, homeless liaison, migrant coordinator at phone #] ESE WOR IMWAN A FEITO SENI EW FÉNU A SU SENI MWAN

KINIKIN 4. KAPACHANAPEN UNUSEN AN CHÓÓN EWE IIM MONI TONONG. Kopwe ereni kich fite ukukun me fan fite (omw angei).

1. ITAN(Makkei chok chóón ewe iimw mi wor ar moni tonong)

2. MONI TONONG MWEN TAKISES ME FAN FITE KA ANGEI

Niwinum seni om angang mwen met epwe

keimu me non

Wenfeer, aninisin semiriit (child support),

moni a no ngeni punuwom fansoun imwu

fesen-ese chiwen pupunu (alimony)

Pension (monien ritaer sen om angang), monien

ritaer, sooson sikiuriti, SSI,

aninisin chóón ra piin nomw non sounfiu

Meinisin moni tonong me nukun

(Awewe) Jane Smith $199.99/iteitan wiik$149.99/iteitan mwirin ruu wiik $99.99/iteitan maram $50.00/iteitan maram

$______/___________________ $______/___________________ $______/___________________ $______/___________________

$______/___________________ $______/___________________ $______/___________________ $______/___________________

$______/___________________ $______/___________________ $______/___________________ $______/___________________

$______/___________________ $______/___________________ $______/___________________ $______/___________________

$______/___________________ $______/___________________ $______/___________________ $______/___________________

$______/___________________ $______/___________________ $______/___________________ $______/___________________

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Taropwen ApinikeisonPeich 1 / 3July 2011 - Chuukese

KINIKIN 5. SIKINICHER ME EKKEWE RUANU NÁSINÓÓN NAMPAN SOOSON SIKIURITI (MI WATTE EPWE SAINI)

Emon chóón non ewe iimw mi watte epwe saini ei taropwen apinikeison. Ika kinikin 4 a wes ne amasow, ewe mi watte a saini ei taropwe epwe pwan makkeitiw ekkewe ruanu násinóón nampan noun sooson sikiuriti ika cheki ewe pwór a mak “Ese wor nampan nei sooson sikiuriti”. (Nengeni met mi mmak nukunupan ei taropwe.)

Uwa apwon me anetatá pwe meinisin pworaus won ei taropwen apinikeison mi ennet me unusen moni tonong mi pwan affat. Uwa weweiti pwe ewe sukuun epwe angei monien aninis seni mwuun anongonong won ekkewe pworaus uwa awora. Uwa weweiti pwe ekkewe chóón angangen ewe sukuun repwe pwan cheki fichi ekkei pworaus. Uwa weweiti pwe ika upwe awora pworaus ese ennet, nei kewe semiriit ra tongeni resapw nounou/eaea aninisin mongo, iwe ngang mi pwan tongeni tipis ren.

Saini ikei: _____________________________________________________________________ Makkei itomw:

Pwinin Maram:

Address/Neniom:____________________________________________________________ Nampan fon:

City/Neni:____________________________________________________________________ State/Mwu/Fénu:________________ Zip Code:

Ekkewe Ruanu Násinóón napmpan sooson sikiuriti: * * * - * * - ___ ___ ___ ___ Ese wor nampan nei sooson sikiuriti

KINIKIN 6. CHÓÓN IA EKKEWE SEMIRIIT (NEMENIOM OMW AMASOWA)

Finata ew ekkei ika omw kewe newo chóón ia

Finata ew ika nap seni (esapw chok ika omw kewe newo chóón ia):

Hispanic/Latino

Not Hispanic/Latino

Asian American Indian ika Alaska Native Black ika African American

White Wesetaan chóón Hawaii ika chóón non fénuwen Pasifik

KOSAPW AMASOWA EI KINIKIN. EI SUKUUN CHOK EPWE EAEA.

Férun fite ewe moni tonong non ew ier: Iteitan wiik x 52, Iteitan mwirin 2 wiik x 26, Fan ruu non ew maram x 24 iteitan maram x 12

Kapachanapen moni tonong: ____________ Non: wiik, mwirin 2 wiik, Fan ruu non ew maram, maram, ier

Chóchóón non ewe iimw: ________

Pungunón Tufichin Aninis: ___ Ráánin a angesafani: ________Tufich (ngeni): Ese kamé___ Kekisinó___ Ese ketiw___

Pwopwun: ________________________________________________________________________________

Non mochomochun fansoun: Ese kamé_____ Kekisinó_____ Fansoun: ___________ (epwe much manamanen mwirin _____ ráán)

An ewe chóón angang a finata pungun sikinicher: ________________________________________________ Pwinin maram: ______________

An ewe chóón angang a apunganó sikinicher: _____________________________ Pwinin Maram: ___________

An ewe chóon anetatá sikinicher: _______________________________ Pwinin Maram: ________


Noumw kewe semiriit ra tongeni aninis an esapw kamé ika epwe kekisinó niwin aner monogo ika pwe moni tonong ngeni chóón no imwomw we a nomw fan ewe eukuk non ei chepen.

Ewe annuk Richard B. Russell National School Lunch Act a annukatiw ekkei pworaus won ei taropwen apinikeison. En mi tongeni omw kosapw awora ekkei pworaus, nge ika kosapw (awora ekkei pworaus), sisapw tongeni etiwa noum we ren an esapw kamé ika ipwe kekisinó niwinin anan mongo. Kopwe apachanong ekkewe ruanu násinóón nampaan sooson noun ewe mi watte chóón non ewe iimw a saini ewe taropwen apinikeison. Ekkewe ruanu násinóón nampaan sooson ese pwan annukutiw omw kopwe awora ika ka tungor aninis fan itan emon semiriit mi nomw fan nemeniem mwuun (foster) ika ke makkei ewe prokramen aninisin mongo (SNAP), Aninisin ekkewe famine mi osupwang non mochomochun fansoun (TANF) Program ika prokramin inetin mongo ngeni ekkewe nenien Indian (FDPIR) nampan keis ika pwan ekkóóch pisekin pwarata an noum we eaea/nounou aninisin FDPIR ika fansoun kopwe affata pwe ewe mi watte chóón non imwomw we a saini ewe taropwen apinikeison ese wor noun sooson sikiuriti nampa. Sipwe ne eaea ekkei pworaus ne apunganó ika noumw we epwe tufichin angei aninisin an esapw kamé ika epwe kekisinó anan mongo, me ren apechokunan annukun ewe prokramen mongon nesor me neanowas. SA TONGENI pwan ngeni ekkewe ekkóóch prokram ren pekin sukuun, safei me mongon apechokun pworausan omw tufich (eligibility) an epwe anisir ne nenengeni ééch, awora monian, ika sine sokkun aninis ngeni ark ewe prokram,, ekkewe chóón akkotaééchu nounoun moni non ekkewe prokram, me chóón apechokuna annuk an epwe anisir ne nengeniééchu annukun ekkewe prokram an esapw ta.

Pworausan an esapw wor etiwangawa/aninisingaw ngeni emon: Ei a awewei met kopwe fééri ika kopwe meefi pwe en mi ketiw engaw (esor popun). “Non pechokunen An mwuun me an mwuun Merika we Putain atake annuk, ei ofes a annukutiw an epwe aninisingaw ngeni emon anongonong won ii chóón ia, enuen inisin, meni fénu a feito seni, ika ii mwan ika fefin, ierin ika terin. Omw kopwe faenini omw chóón anisuk re aninisingaw ngonuk, mmak ngeni USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 ika kéri call ei nampa ese kamé (866) 632-9992 (pworaus). Ekkewe mi pung seninger ika rese kon rongorongééch ika terir a weneiti non pekin pworaus ra tongeni kééri USDA won an ewe Federal Relay Service won (800) 877-8339; ika (800) 845-6136 (Fosun Spain). USDA ew neni a awora anénné pekin aninis.”


CHEPENIN TUFICHIN ANINIS ANONGONGO WON MONI TONONGFEDERAL non ei ierin sukuun________

Chóchóón ewe iimw Iteitan ier Iteitan maram Iteitan wiik

1

2

3

4

5

6

7

8

Pwan ekkoch aramas (chón non ewe iimw):

EAEA FENGENIN PWORAUS ME MEDICAID/SCHIP

Achengicheng saam me iin/Chóón tumwun:

Ika pwe noum we semiriit a angei anan mongo nge ese kamé ika mi kekis niwinin anan mongo, rap wan tongeni angei nour insuransin safei esapw kamé ika epwe kekis niwini seni Medicaid ika ewe prokram an ei mwuu fan iten pekin aninisin insuransin safei ngeni semiriit (SCHIP). Semiriit mi wor nour insuransin safei ra kan angei tumwunun safei me a pwan chókukkun fansoun ar etiwa sukuun pwokiten semwen.

Pwokiten insuransin safei a men auchea me namwot ngeni pechokunen ewe semiriit, ewe annuk a mwut ngeni kich ach sipwe ereni Medicaid me SCHIP pwe noum we a tongeni nounou aninisin an esapw kamé ika kekis niwinin anan mongo, chilon chok ika kopwe erenikich pwe sisapw (ereniir). Medicaid me SCHIP ra chok eaea ekkei pworaus ren ar repwe sine ika ekkewe semiriit repwe tufich ngeni ekkei prokram. Chóón angangen ei prokram repwe kékkeruk ar repwe erenuk ika kopwe atononga noumw kewe semiriit. Amasowan ewe taropwen apinikeison ren an esapw kamé ika epwe kekisinó niwinin mongo ese pwan atononga noumw we non ewe pekin insuransin safei.

Ika kose mochen ngeni Medicaid ika SCHIP ekkei pworaus fan itomw, amasowa ei taropwe fan ka tinanong (Omw tinanong ei taropwe esapw siwini an noumw ew angei anan mongo esapw kamé ika mi kekis niwinin.).

Aapw! USE mochen pworaus seni nei we taropwen apinikeisonun an esapw kamé ika epwe kekisinó niwinin mongo epwe nó Medicaid me ewe prokram an mwuun fan iten aninisin insuransin safei ngeni semiriit.

Ika ke cheki aapw, amasowanó ei taropwe fan an ekkewe pworaus fan itomw ESAPW ngeni emon ren ekkei semiriit a mak iter fan:

Itan semiriit: ___________________________________________ Itan sukuun:___________________________________________________




An iin me saam/Chon tumwun sikinicher: _________________________________________Pwinin maram: _________________

Makkei itomw:___________________________________________________________________________________________________________

Address/Neniom:________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Ren pwan ekkóóch pworaus, ka tongeni kékkéri [name] won [phone] ika e-mail ngeni won [e-mail address].

Eniwin ei taropwe ngeni: [address] mwen [date] .

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Eaea fengenin pworaus me Medicaid/SCHIP Peich 1 / 1July 2011 - Chuukese

EAEA FENGENIN PWORAUS ME EKKÓÓCH PROKRAM

Achengicheng saam me iin/Chóón tumwun:

An esapw nusumwan fansoun me omw angang, ekkei pworaus ka awora won noumw we taropwen apinikeisonun an esapw kamé ika epwe kekisinó niwinin mongo a tongeni sipwe ngeni ekkewe pwan ekkóóch prokram noumw we a pwan tongeni aninis. Ren ekkei prokram fan, sipwe angei mwumwuta sonuk ach sipwe ngeni (emon) ekkei pworaus fan itomw. Omw tinanong ei taropwe esapw siwini an noumw we tufichin esapw kamé ika epwe kekisinó niwinin anan mongo.

Ewer! Ngang mi mochen ekkewe chóón angangen sukuun repwe ngeni [name of program specific to your school] ekkewe pworaus won nei we taropwen apinikeisonun an esapw kamé ika epwe kekisinó niwinin mongon sukuun.



Ika ke cheki ewer ngeni ew ika meinisin ekkei pwór asan, amasowanong ei taropwe an ekkewe pworaus fan itan ekkewe semiriit mi mmak iter fan sipwe ngenir. Ekkei pworaus sipwe ngeni chok ekkewe prokram ka cheki.





An iin me saam/Chon tumwun sikinicher: _________________________________________Pwinin maram: _________________

Makkei itomw:___________________________________________________________________________________________________________

Address/Neniom:________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Ren pwan ekkóóch pworaus, ka tongeni kékkéri [name] won [phone] ika e-mail ngeni won [e-mail address].

Eniwin ei taropwe ngeni: [address] mwen [date] .

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Eaea fengenin pworaus me Medicaid/SCHIP Peich 1 / 1July 2011 - Chuukese

SIPWE CHEKI NOUMW EI TAROPWEN APINIKEISON

Kopwe tinato ekkewe pworaus sia mochen, ika kékkéri [name] mwen [date], me ika noum we (kewe) epwene/repwene kounó ne angei ekkewe mongo ese kamé ika mi kekis niwinin.

Sukuun: ___________________________________________________________________Pwinin maram: ______________________

Achengicheng _________________________________________________:

Sia cheki noumw we taropwen apinikeisonun an esapw kamé ika kekis niwinin mongon sukuun. Annukun mwuun Merika a annukatiw pwe sipwe fééri ei (cheki apinikeison) ach sipwe anneta pwe ekkewe chok semiriit ra tufichin eaea ei aninisin an esapw kamé ika kekis niwinin mongo repwe angei ei aninis. Kopwe tinato pworausen annetatá pwe [name(s) of child(ren)] a tongeni aninis.

Ika mi tufich, tinato kapiin, nge esapw ekkewe orichinal. Ika ke tinato ekkewe orichinal, sia tongeni tini sefan ngonuk ika chok ke tungor.

1. IKA EN MI ANGEI ANINIS SENI [State SNAP], [State TANF] IKA [FDPIR] FANSOUN OMW TUNGOR FAN ITAN AN EPWE KAMÉ IKA KEKISINÓ NIWIN MONGO, IKA KOPWE TUNGOR ANINISIN AN ESAPW KAMÉ IKA EPWE KEKISINÓ NIWIN MONGO, IKA PWAN NON EW FANSOUN MWIRIN KA TINATO KAPIIN EW ME NEIN EKKEI:

[State SNAP] ika [State TANF] ika [FDPIR] esinesin mi impang epwe pwarata pwinin maramen an impang.

Taropwe seni ofesin [State SNAP] ika [State TANF] ika [FDPIR] epwe pwarata pwinin maramen impang.

Kosapw tinato noum we EBT card.

2. IKA KA ANGEI EI TAROPWE FAN ITEN EMON SEMIRIIT ESE WOR IMWAN, EMON A FEITO SENI PWAN EW FÉNU, IKA A SU SENI IMWAN, KOSE MOCHEN KÉÉRI [school, homeless liaison, or migrant coordinator] REN ANINIS.

3. IKA PWE EWE SEMIRIIT MI NOMW FAN NEMENIEM MWUUN (FOSTER): Awora taropwen pwarata pwe ewe semiriit ii a nomw fan wisan tumwunuan ewe ofes ika kapwung a affat non annuk ika awora itan ewe aramas seni ewe ofes ika kapwung a tongeni pwarata pwe ewe semiriit ii mi nomw fan nemenien mwuun.

4. IKA ESE WOR CHÓÓN NON IMWOMW WE A ANGEI ANINIS SENI [State SNAP] ika [State TANF] ika [FDPIR]:Tinanong ei peich fengen me taropwe epwe affata ukukun moni tonong ngeni chóón non imwomw we. Ekkewe taropwe kopwe tinato epwe nomw itan ewe armas an ewe moni tonong, pwinin maramen an angei, fite a angei, me fan fite a kan angei. Tinano ekkei pworaus ngeni: [address]

Taropwe sia etiwa a pachenong:

ANGANG: Risiten peiofomw ika futon niwinumw ewe a pwari ukukun niwinum me fan fite wa kan angei; taropwe seni nenien omw angang epwe affatatiw niwinum mwen ese mwo eimwu takises me ekan fan fita ke kan peiof; nge ika nge pwisin angang ngonuk (omw pisinis), taropwen pisinis ika atake, ren makken monien omw pisinis ika pwuken/taropwen takises.

Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Sipwe cheki noumw we taropwen apinikeisonPeich 1 / 2July 2011 - Chuukese

SOOSON SIKIURITI, MONIEN RITAER SENI OMW ANGANG, IKA MONIEN RITAER: taropwen aninisin ritaer ren sooson sikiuriti, taropwen aninis en mi angei, ika esinesin ren monien ritaer seni omw nenien angang.

ESE WOR ANGANG (UNEMPLOYMENT), TER (DISABILITY), IKA ANINISIN FEIENGAWAN NON ANGANG (WORKER’S COMP): Esinesin won tufichin aninis seni an mwuun we ofesin sooson sikiuriti, risiten peiofomw, ika eché taropwe seni ewe ofesin aninisin feiengaw ngeni chóón angang.

NIWININ WENFER: Taropwen aninis seni ewe ofesin [State TANF].

ANINIS NGENI SEMIRIITIKA SENI PUNUWOM FANSOU OUWA MWU FESEN (ALIMONY): An kapwung we pwuung, etipeew, or copies of checks received.

EKKÓÓCH MONI TONONG (REN MONI SENI IMWEN RENT): Pworaus epwe pwarata ukukun ewe moni tonong ka angei, fan fite omw angei, me pwinin maramen omw angei.

ESOR MONI TONONG: Eché mochomochun taropwe epwe awewei ifa usun omw awora anomw mongo, uuf, me pwan meni ewe iimw fan itan chóón non imwomw, me inet ka ekieki pwe epwene wor omw moni tonong.

PEKIN ANINISIN IIMW NGENI SOUNFIU: Taropwe ika ewe taropwe atipeewan rent epwe pwrata pwe imwomw ei seni pekin aninisin iimw ngeni sounfiu.

FANSOUN A KETIW EKKEWE TAROPWEN MONI: Kose mochen tinato taropwen pwarata ren omw moni tonong non ew maram; ka tongeni nounou taropwen ewe maram a nó mwen chok ei taropwen apinikeison, ewe maram ka tungor non, ika ese pwan nifinifin maram me mwirin.

Ika epwe wor omw kapas ei ika mochen aninis, kose mochen kékkéri [name] won [phone number]. Ei kékké ese kamé. [Toll free or reverse charge explanation]. Ka pwan tongeni e-mail ngeni kich won [e-mail address].

Sincerely,

[signature]

Ewe annuk Richard B. Russell National School Lunch Act a annukatiw ekkei pworaus won ei taropwen apinikeison. En mi tongeni omw kosapw awora ekkei pworaus, nge ika kosapw (awora ekkei pworaus), sisapw tongeni etiwa noum we ren an esapw kamé ika ipwe kekisinó niwinin anan mongo. Sipwe eaea ekkei pworaus ach sipwe sine me apwunganó pwe noum we a tufich ngeni aninisin an esapw kamé ika epwe kekisinó niwinin (anan) mongo, me pwan ren akotun me apechokunen ekkewe prokramin mongon neanowas me nesossor.



SA FEN CHEKI NOUMW EI TAROPWEN APINIKEISON

Sukuun: ______________________________________________________________________Pwinin maram: ______________________

Achengicheng _________________________________________________:

Sa fen cheki ekkewe pworaus ka ngeni kich pwe pisekin pwarata [name(s) of child(ren)] ra tufichin aninis ren an esapw kamé ika epwe kekisinó niwinin mongo iwe sia apunganó pwe: An noum kewe tufich ngeni ekkei aninis ese siwin. Pwopwuta [date] , an noumw we (kewe) tufichin aninis ren mongo epwene siwin seni ewe a kekisinó

niwinin nge an esapw chiwen kamé pwun omw we moni tonong a nomw non aukukun moni tonong a tufich ngeni esapw chiwen kamé (anan) mongo. Noumw we (kewe) repwene angei aner esapw kamé.

Pwopwuta [date] , an noumw we (kewe) semiriit tufichin aninisin mongo epwene siwin seni ese kamé ngeni an epwene kekis niwinin pwun omw we moni tonong a nuseni ewe aukuuk. Kekisinó niwinin mongo ukukun [$] ren mongon neanowas me [$] ren mongon nesossor.

Pwopwuta [date] , noumw we(kewe) rese chiwen tufich ngeni aninis an esapw kamé ika kekisinó niwinin aner mongo ren ekkei pwopwun mi affat:___ Neuch taropwe a pwarata nge ese wore mon chóón ewe iimw a angei aninis sen [State SNAP] ika

[State TANF]. ___ Neuch taropwe a pwan pwarata pwe noumw we (kewe) esapw iir ekkewe ese wor imwer, su seni

imwer ika feito seni pwan ew fénu. ___ Omw moni tonong a nuseni ewe aukuk ren an esapw kamé me epwe kekisinó niwinin mongo.___ Kose awora: ______________________________________________________________________________________ ___ Kose pénuweni ach we tungor.

Niwinin mongo [$] ren mongon neanowas me [$] ren mongon nesossor. Ika moni tonong ngeni chóón non ewe iimw a pwan kukununó ika chóchón non ewe iimw ra chommongonó, ka tongeni tungor. Ika en mi piin eniwin ika kosapw ketiw ren ekkei aninis pwun esor emon chóón non imwomw we mi angei aninis seni [State SNAP], [State TANF] ika [FDPIR], ka tongeni tungor sefan anongonong won tufichin aninis ren omw moni. Ika kose awora pisekin pwarata ren omw tufichin angei/eaea ekkei aninis, ina sipwe tungoreok kopwe awora ika ka tungor sefan.

Ika kose tipeew ngeni met a kapungunó, ka tongeni pworaus ngeni [name] won [phone]. A pwan wor omw pwuung ngeni ew arongorong. Ika ka tungor ew arongorong mwen [date], noumw we (kewe) repwe sopwosopwonó ne angei aner mongo esapw kamé ika epwe kekis niwinin tori an ewe chóón arongorong a apunganó pungun. Ka tongeni tungor ew arongorong omw kopwe kékkéri ika mmak ngeni: [name], [address], [phone number], ika [e-mail].

Sincerely,

[signature]



ESINESIN NGENI CHÓÓN EWE IIMW REN AN KETIW/ESE KETIW REN ANINIS

Achengicheng iin me saam/Chóón tumwun:

Ka tungor fan itan an esapw kamé ika epwe kekisinó niwinin mongo fan itan ekkei semiriit;

_______________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ _______________________________________________________

Noumw we taropwen apinikeison a:

Ketiw an esapw kamé

Ketiw ren niwinin mongo mi kekisinó ngeni $ __________ ren mongon neanowas, $ ____________ ren mongon nesossor, me

$ ____________ ren mongon nefinen mongo

Ese ketiw ren ekkei pwowpun:

Moni tonong a nu seni ewe aukuuk a mwumwutá

Ese wes amasowan ei taropwe pwun _________________________________________________________________________

Ekkóóch pwopwun _____________________________________________________________________________________________

Ika kose tipeew ngeni ei pwuung, ka tongeni pworaus ngeni [school official’s name] won [phone number] ika won [e-mail address]. Ika kopwe mochen nengeniééchu ewe pwuung fan itan noumw we taropwe, mi wor omw pwuung ngeni ew arongorong. Ka tongeni kékkéri ika mmak ngeni ekkei chóón:

ITAN: __________________________________________________________________________________________________________________________________

ADDRESS/NEENI: ____________________________________________________________________________________________________________________

NAMPAAN FON: ____________________________________ E-MAIL _________________________________________________________________________

Sincerely,

[signature]

___________________________________________________________________________________________________________________________________________Itan Wiisan Pwinin maram



ESINESIN FAN ITAN ANETATÁ

Achengicheng iin me saam/Chóón tumwun:

Sa mochen esinei ngonuk pwe noumw we (kewe) semiriit a mmak iter fan ra angei aner kewe mongon neanowas ese kamé, mongon nesossor, me ekkewe mongon nefinen kunokun mongo non sukuun pwun ra angei ekkewe aninis seni [State SNAP] ika [State TANF].

Itan ewe semiriit Itan ewe sukuun

Ika pwe mi pwan ekkóóch semiriin non imwomw we ese mmak iter asan, ra pwan tufich ne aninis ren an esapw kamé (aner) mongo.

Kose mochen kékkéri ewe sukuun noumw we a fiti ika epwe fis ekkei:

Ika mi wor ekkóóch semiriit non imwomw we ese mmak iter asan me ka mochen repwe pwan angei aner non ewe sukuun esapw kamé

Kose mochen an noumw kewe esapw kamé aner mongo Mi chiwen wor ekkóóch omw kapas eis

[name]

[phone]

[e-mail address]

Sincerely,

[signature]


Taropwen apinikeison an esapw kamé ika epwe kekisinó niwinin mongon sukuun Esinesin Fan Itan AnnetatáPeich 1/ 1July 2011 - Chuukese

2011 application & instructions - hawaii child nutrition...

Documents