Kansas State Department of Education



Insert District letterhead or logo

Date:

Director of Food & Nutrition Services,

Any school district

Capital City, Kansas

I certify that under the McKinney-Vento Act, ____________________________ (student’s name)

attending ___________________________ qualifies for the National School Lunch

(attendance school)

Program by virtue of their status as a Homeless Person.

_____________________________

John Smith, McKinney-Vento Liaison

Homeless Liaison/City Public Schools

City Public Schools, USD 999

Capital City, Kansas, 12345

Dr. Jane Jones

Superintendent of Schools

City Public Schools, USD 999

Capital City, Kansas 12345

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