State/Local: J - Changes in Student Certification and Enrollment Form

OMB Approval No.: 0584-0530

Approval Expires:

CHANGES IN STUDENT ELIGIBILITY STATUS AND ENROLLMENT FORM (continued)

NSLP AND SBP ACCESS, PARTICIPATION, ELIGIBILITY, AND CERTIFICATION STUDY (APEC-II)

_{CHANGES IN STUDENT ELIGIBILITY STATUS AND ENROLLMENT FORM}

_{SCHOOL IDENTIFICATION NUMBER: | | | | | | | | |}

_{SFA ID #: | | | | | | | | |}

INSTRUCTIONS: FOR THE STUDENTS LISTED BELOW, PLEASE RECORD THE NEW MEAL ELIGIBILITY STATUS AND THE DATE OF ALL CHANGES FOR EACH STUDENT DURING THE SCHOOL YEAR. MEAL ELIGIBILITY STATUS CODES ARE: F = FREE, RP = REDUCED PRICE, AND P = PAID (SOMETIMES CALLED “FULL PRICE”). ALSO RECORD WHETHER THE STUDENT LEFT THE STUDY SCHOOL BEFORE THE END OF SCHOOL YEAR AND, IF SO, WHEN THE STUDENT LAST ATTENDED SCHOOL.

A. LIST OF SAMPLED STUDENTS NAME:	B. FOR EACH STUDENT ANSWER: Did STUDENT’s meal eligibility status change during the school year?	C. When did the meal eligibility status change?	D. What was the new meal eligibility status?	E. Did STUDENT leave school before the end of the school year?	F. When did STUDENT last attend this school?
1. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
2. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
3. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P

A. LIST OF SAMPLED STUDENTS NAME:	B. FOR EACH STUDENT ANSWER: Did STUDENT’s meal eligibility status change during the school year?	C. When did the meal eligibility status change?	D. What was the new meal eligibility status?	E. Did STUDENT leave school before the end of the school year?	F. When did STUDENT last attend this school?
4. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
5. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
6. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
7. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
8. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P

A. LIST OF SAMPLED STUDENTS NAME:	B. FOR EACH STUDENT ANSWER: Did STUDENT’s meal eligibility status change during the school year?	C. When did the meal eligibility status change?	D. What was the new meal eligibility status?	E. Did STUDENT leave school before the end of the school year?	F. When did STUDENT last attend this school?
9. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
10. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
11. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
12. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
13. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P

A. LIST OF SAMPLED STUDENTS NAME:	B. FOR EACH STUDENT ANSWER: Did STUDENT’s meal eligibility status change during the school year?	C. When did the meal eligibility status change?	D. What was the new meal eligibility status?	E. Did STUDENT leave school before the end of the school year?	F. When did STUDENT last attend this school?
14. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
15. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
16. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
17. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
18. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P

A. LIST OF SAMPLED STUDENTS NAME:	B. FOR EACH STUDENT ANSWER: Did STUDENT’s meal eligibility status change during the school year?	C. When did the meal eligibility status change?	D. What was the new meal eligibility status?	E. Did STUDENT leave school before the end of the school year?	F. When did STUDENT last attend this school?
19. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
20. | | |	B. YES .. (ANSWER C & D THEN E) .........1 NO .... (ANSWER E) ......0	C. MONTH / DAY / YEAR	D. MEAL STATUS	E. YES .... (ANSWER F) .. 1 NO .... (GO TO NEXT STUDENT) ...... 0	F. MONTH / DAY / YEAR | | | / | | | / | | |
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P
		| | | / | | | / | | |	F RP P

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 0584-0530. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collected.