How to Complete the Application for Educational Benefits

List every child, infant, and student living in your household, whether they are related to you or not.

• Include their date of birth, school name, and current grade.
• Check the "Foster Care" box if a child is placed in your home through a welfare agency or court.

If anyone in your household currently participates in SNAP, MFIP, or FDPIR, write your official case number in this section.

• If you provide a valid case number, you can skip Step 3 and go straight to Step 4.
• If no one in your household uses these programs, leave Step 2 blank and move to Step 3.

If you did not provide a case number in Step 2, you must report the current gross income (before taxes and deductions) for all household members.

(Note: Your total household income will be compared to federal guidelines to determine your eligibility. You do not need to calculate this yourself. School staff will review your totals after you submit the form.)

• Child income: List any regular income received by children, such as part-time job pay or SSI benefits. Mark how often they receive it.
• Adult income: List the names of all adults living in the household and their exact incomes. Enter a "0" for any adult with no income to report.
• Self-employed/farmers: List your net income (after business expenses). If your business operates at a loss, enter "0".
• Other income sources: Include funds received from child support, alimony, unemployment, social security or pensions.
• Social Security number: An adult household member must write the last four digits of their Social Security number or check the box indicating they do not have one.

An adult household member must sign and date the application to certify that all information is true.

• Health care privacy: If you do not want your status shared with Minnesota Health Care Programs, check the "Don't share" box in this section.

• Gross income: Always report income before taxes, not your final take-home pay. Do not list hourly wage rates or occasional earnings like babysitting.
• Citizenship status: You do not have to be a U.S. citizen to apply or qualify for benefits.
• Privacy protections: All details you provide are strictly protected as private data under state law.