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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