POSTAL PATRON Bangor School District - School District of Bangor 700 10th Avenue South PO Box 99 Bangor WI 54614 - Amazon AWS
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Non-ProÞt Organization
U.S. Postage Paid
School District of Bangor Permit #3
700 10th Avenue South Bangor WI 54614-0099
PO Box 99
Bangor WI 54614
POSTAL PATRON
Bangor School District
8/4/21 jr
Bangor School District Calendar 2021-2022
August 2021 January 2022 AUGUST 2021
17-18 Registration/Pics - 1:00-7:00
S M T W T F S S M T W T F S 23 Staff Inservice Flex Day
1 2 3 4 5 6 7 1 24-26 Staff Inservice
8 9 10 11 12 13 14 2 3 4 5 6 7 8 SEPTEMBER 2021 (20 Student Days)
15 16 REG REG 19 20 21 9 10 11 12 13 14 15 1 First Day
6 Labor Day (No School)
22 FL INS INS INS 27 28 16 PD 18 19 20 21 22 24 Professional Dev. Day (No School)
29 30 31 23 24 25 26 27 28 29
OCTOBER 2021(20 Student Days)
30 31 15 Professional Dev. Day (No School)
September 2021 February 2022
NOVEMBER 2021 (18 Student Days)
S M T W T F S S M T W T F S 3 End MS/HS Qtr. 1 (43 days)
FD 2 3 4 1 2 3 4 5 4 P/T Conferences (No School)
K-5 - 11:00-7:00
5 6 7 8 9 10 11 6 7 8 9 10 11 12
6-12 - 12:00-8:00
12 13 14 15 16 17 18 13 14 15 PT PD 18 19 5 Professional Dev. Day (No School)
19 20 21 22 23 PD 25 20 21 22 23 24 25 26 23 End EL Trimester 1 (55 days)
24-26 Thanksgiving Break (No School)
26 27 28 29 30 27 28
DECEMBER 2021(15 Student Days)
3 Professional Dev Day (No School)
October 2021 March 2022 23-31 Winter Break (No School)
S M T W T F S S M T W T F S
JANUARY 2022 (20 Student Days)
1 2 1 2 3 4 5 17 Professional Dev. Day (No School)
3 4 5 6 7 8 9 6 7 8 9 10 11 12 21 MS/HS End Qtr. 2 (43 days)
10 11 12 13 14 PD 16 13 14 15 16 17 PD 19
17 18 19 20 21 22 23 20 21 22 23 24 25 26 FEBRUARY 2022 (18 Student Days)
16 P/T Conferences (No School)
24 25 26 27 28 29 30 27 28 29 30 31 K-5 - 11:00-7:00
31 6-12 - 12:00-8:00
17 Professional Dev. Day (No School)
November 2021 April 2022 18 No School
S M T W T F S S M T W T F S
MARCH 2022 (21 Student Days)
1 2 3 PT PD 6 1 2 4 End EL Trimester 2 (58 days)
7 8 9 10 11 12 13 3 4 5 6 7 8 9 18 Professional Dev. Day (No School)
21 No School
14 15 16 17 18 19 20 10 11 12 13 PD 15 16 30 End MS/HS Qtr. 3 (43 days)
21 22 23 24 25 26 27 17 18 19 20 21 22 23
28 29 30 24 25 26 27 28 29 30 APRIL 2022 (18 Student Days)
14 Professional Dev Day (No School)
15,18 Spring Break (No School)
December 2021 May 2022
S M T W T F S S M T W T F S MAY 2022 (20 Student Days)
13 Professional Dev Day (No School)
1 2 PD 4 1 2 3 4 5 6 7 29 HS Graduation - 1:30
5 6 7 8 9 10 11 8 9 10 11 12 PD 14 30 Memorial Day (No School)
12 13 14 15 16 17 18 15 16 17 18 19 20 21 JUNE 2022 (3 Student Days)
19 20 21 22 23 24 25 22 23 24 25 26 27 28 3 Last Day (Early Release -
11:20/11:30)
26 27 28 29 30 31 29 30 31 End MS/HS Qtr. 4 (42 days)
End EL Trimester 3 (58 days)
7 1st Snow Make up Day (if needed)
June 2022 (Extending the school day or virtual
S M T W T F S instruction may be considered if
1 2 LD 4 additional make up time is needed)
5 6 7 8 9 10 11
Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
Welcome Back!! Instead of focusing on scores primarily in literacy and math,
From District Administrator David Brokopp we have made a transition to an increased emphasis on
growth in all academic areas. This shift will encourage every
New Beginnings and Rich Traditions:
staff member to engage in a goal setting process for their
As the month of August kicks off, the start of the 2021 -
own content areas and demonstrate the growth of students
2022 school year promises to be a year filled with new
over the course of the year. While we will still closely
beginnings and a return to many rich traditions from the
monitor the measurable performance of our students in
past. While the pandemic is not completely in our rearview
literacy and math, we want to ensure that every program
mirror, the opportunities for vaccinations and lessons
and subject area in our system feels included in our district
learned from the past year and a half have the district
goals and that everyone is working toward improved
positioned to start the year in a way that feels a whole lot
outcomes for our students.
closer to “normal” than we have felt for a long time. It is
Adding to the new beginnings, as the new superintendent, I
important that we do not completely let our guards down.
could not be more excited to join the Bangor community.
As a district we will continue to closely monitor conditions
As we all know, it is always a great day to be a Bangor
and be prepared to increase safeguards to protect our
Cardinal. After a couple of months in the community, I
students, staff, and families. As it stands right now, it is
couldn't agree more. The commitment of the District and
exciting to plan for a year where we will see children in
community to the mission of the district is evident. Bangor
school, in co-curricular activities, and interacting with
Pride: A Small School Building Big Futures. As
friends and district staff in ways that we have not been able
superintendent, I will lead for the greater good of our
to do through the pandemic.
schools and community. We will build on the rich traditions
The conference schools are all ready for a traditional fall
and maintain an environment that attracts and retains high
season and there is a great deal of excitement for our
quality educators and dedicated families. Our schools,
student athletes and their families as we return to these
students, and educators will be the foundation of our
activities. Registration will again have a face to face
community.
component this year with all students having the
As a community, we all have the ability to help to make the
opportunity to get their school pictures taken for the year.
2021-2022 school year be the best possible for our
As a district, we have made a minor adjustment to our goal
students. Let's make this an amazing school year!
setting process that we hope will make a major impact.
David Brokopp
Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
Registration for Middle/High School Registration for Elementary
Most of the registration process should be completed Most of the registration process should be completed
online at www.bangor.k12.wi.us and fees may be paid online at www.bangor.k12.wi.us and fees may be paid
online through JMC. online through JMC.
Registration times for fall of 2021 will be as follows: Registration for 4K-5th grade students will be held in
Tuesday, August 17th, from 1 to 7 p.m. and the Bangor Elementary School office on Tuesday,
Wednesday, August 18th, from 1 to 7 p.m. At this August 17th, from 1-7 p.m. and Wednesday,
time students will have pictures taken and families may August 18th, from 1-7 p.m. Pictures will be taken.
turn in medication forms and free and reduced Free and reduced meal applications may be turned in
applications. during registration, as well as medical forms.
*Note: We will be taking your students’ photos, Pictures of students will be taken in the multi-
including seniors, so they need to accompany you to purpose room.
registration. Elementary School Open House is Wednesday, August
Bangor Virtual Academy (formerly CRVA) will be 25th, 5:30-6:30 p.m. Open House is a time to meet
available for students in grades 7-12. BVA students the teachers and drop off supplies.
must complete the online registration and
paperwork.
Notice of Budget Hearing
FEES
Registration fees help to defray the cost of
consumable materials. Notice is hereby given to qualified electors of the
Registration fees are as follows: School District of Bangor that the Budget Hearing will
4K Students, Bangor Elementary $2.00 be held in the Bangor High/Middle School cafetorium
K-5 Students, Bangor Elementary $5.00 on Wednesday, the 27th day of October, 2021 at 7:00
High/Middle School Students $10.00 p.m. Copies of the budget will be on file in the District
Students are asked to pay a part or all of the cost of Administrator's office during normal working hours.
individual projects. Individual projects are made in Dated July 21, 2021
Family and Consumer Education, Art, and Technology Michele Piske, Clerk
Education.
Parents please note: Fees may be paid online
through JMC. The processing fee for payments
(including the registration fee, lunch money, and sports Notice of Annual District Meeting
passes) made on JMC will be waived if the payments
are made on August 17th or 18th.
Notice is hereby given to qualified electors of the
School District of Bangor that the Annual Meeting will
6th and 9th Grade Orientation be held in the Bangor High/Middle School cafetorium
Middle/High School Cafetorium on Wednesday, the 27th day of October, 2021,
Tuesday, August 24th, 2021 immediately following the budget hearing.
6th Grade: 6:00 p.m. Dated July 21, 2021
9th Grade: 7:30 p.m. Michele Piske, Clerk
2Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
Medication Guidelines
All practitioner's offices have the medication
The school nurse serves the two school buildings
administration form. Your child's practitioner can fax
during the school day, Monday - Friday in the
the form with their signature to the elementary school
Bangor School District. In addition to promoting
at 608-486-4045 or the high/middle school at
wellness and safety, the nurse supervises the care of
608-486-4587.
ill and injured students, supervises the distribution of
The nurse’s office has some over the counter
medication, reviews immunization records, and
medications available for children. If necessary, we
conducts hearing and vision screenings.
may ask you to supply an over the counter
Designated, trained school staff will administer
medication depending on your child's needs.
medication to students that must be given at exact
It is the responsibility of the parents to pick up any
times during school hours. The school district
remaining medication, inhalers, etc. at the end of the
requests that students who need medication three
school year. The disposal of expired medications,
times a day, for example, take it before school, after
inhalers, Epi-Pens, etc., is the responsibility of the
school, and at bedtime, when possible.
parents.
Parents with students needing to take prescription
medication on a daily schedule at school will need
to contact the school nurse prior to the start of
the school year at 608-486-5250.
There must be a completed medication
administration form on file before any medication, The Coulee Region SPARKS Group has partnered with
p re s c r i p t i o n o r o v e r- t h e - c o u n t e r, w i l l b e @Bright by Text to bring the program to you! Whether
administered. This includes Tylenol Jr., and you’re a parent, grandparent, aunt or uncle, neighbor,
Ibuprofen Jr., etc. The medication administration or babysitter, Bright by Text can make caring for a little
form is available to print from the Bangor School one easier! Expecting parents and children up to age
District website www.bangor.k12.wi.us under the 8 can receive free tips and learning games directly to
registration tab/health documents. Copies are also your phone, text SPARKS to 274448 or go to
available in each school's main office. Only a www.brightbytext.org www.brightbytext.org
parent’s signature is required for manufacturers
recommended doses of Tylenol and Ibuprofen.
All medications (prescriptions, including inhalers &
Epi-Pens, over the counter, cough drops,) must be
provided in the original container with the child's
name, medication name or list of ingredients,
instructions for administration, and expiration date
clearly visible. A practitioner's signature is required
for all prescription medications and for all over-the-
counter medicines when a dosage exceeds the
manufacturer's therapeutic dose.
3Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
ELEMENTARY SCHOOL BANGOR HIGH/MIDDLE SCHOOL STUDENT
Class Assignments
DRESS CODE
Elementary school class assignments will be mailed
Responsibility for the personal appearance of students
home after registration. When children arrive the first
day, 4K students will be assisted to their classroom enrolled in the School District of Bangor shall normally rest
when the bus unloads at entrance B. They will be the with the students and their parents/guardians. Students
first students dropped off. Kindergarten - 5th graders dress or grooming should not, however:
need to report to the playground. Staff will meet them • affect the health or safety of individuals on school
there. property.
Allergy Awareness • disrupt the learning process within the classroom or
Due to the number of staff and students with food school.
allergies, all treats/snacks brought to the elementary Students should wear clothing that is reasonably clean
school will require a list of ingredients. and appropriate for an educational environment. Clothing
Student Dress Code deemed inappropriate by staff and administration shall be
The appearance and clothing of the student should prohibited at school activities.
not cause interference or disruption of the learning Clothing which will be deemed inappropriate includes,
atmosphere. but is not limited to, the following:
1. Shirts with designs or writing on them should not • all students shall wear pants at the waistline. Skirts should
be offensive (for example, obscenities or alcohol be no more than a hand-width above the knee. Shorts and
and tobacco promotions). skorts should have an inseam measuring at least 4 inches.
2. Caps and hats must be removed from the head Torsos need to be covered, including midriffs, chests, back,
upon entering the building. and from neck to shoulder. All students shall wear clothing
3. Sandals with heel straps may be worn during the that completely covers all undergarments. All students
day. should wear footwear while at school activities.
4. All students will be expected to wear boots when • no person shall wear clothing that contains pictures and/
snow is on the ground. or writing (either directly or implied) referring to sexual
5. Tennis shoes (non-platform) are required for physical references, profanity, violence, illegal drugs, or the
education classes. promotion of alcoholic beverages and/or tobacco products,
6. When the weather is warm, students are allowed to or that is racially, ethnically, or sexually provocative or
wear shorts as long as they fit properly. We try to derogatory in the school building during the school day.
go outdoors for recess each day. • no student shall be permitted to wear any coats or
Traffic Safety Pattern headgear (cap, hat, hood, etc.) in the school building during
Buses will drop students off in the loop before the school day unless it is for religious or medical reasons.
proceeding east with high/middle school students. The • backpacks / book bags are to remain in student's locker
loop is for buses only during loading/unloading. during the school day.
Parents should drop students off at the main entrance If there is a disagreement between students and/or
A, drive south to the end of 14th Ave. South, left into parents and the staff regarding the appropriateness of
one-way entrance with curbside drop off and angle clothing, the principal will use his/her discretion to make the
parking. Please drive slowly and watch for the safety of decision.
students.
4Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
STUDENT PHYSICAL EXAMS
Physical exams are requested of all kindergarten
students. IMMUNIZATION CHECKPOINT LAW
New students are requested to present medical The law requires that parent(s) of children entering
evidence that they are able to compete in the full 4-year-old kindergarten and kindergarten submit
s c h o o l p ro g r a m . A l l s t u d e n t s c o m p e t i n g i n information showing that the children have received
interscholastic athletic activities must have a medical required vaccines. The list of immunizations may be a
examination prior to start of practice. One examination computer print out from your healthcare provider,
takes care of all sports. attached to the Student Immunization Form with your
signature in section 5.
NOTICE TO ALL PARENTS The law provides exemption from the immunization
As a parent of a student in the Bangor School District requirements for personal reason, medical or religious
you have the right to know the professional reason. Parent(s) who choose not to vaccinate their
qualifications of the classroom teachers that instruct child and/or children, must still complete Sections #4 &
your child. The No Child Left Behind federal law allows #5, the Waiver part of the Student Immunization
you to request specific information about your child's Form. This will need to be completed in 4-year-old
classroom teachers and requires that your school kindergarten, kindergarten, and again in 6th Grade.
respond to your request in a timely manner. You have The law requires the school principal to refuse to
the right to ask for the following information in regard admit any child who does not have the immunization
to your child's teachers: history (listing month and year that each dose of the
required immunizations were received) and if
• whether the Wisconsin Department of Public
Instruction has licensed or qualified the teacher for exemption status is not claimed or if the parent does
the grades and subjects he or she teaches; not indicate permission to carry out the required
immunizations. *Please note that the State of
• whether the Wisconsin Department of Public
Instruction has decided that the teacher can teach Wisconsin now requires 2 Chicken Pox Vaccines for
In a classroom without being licensed or qualified all grades and all students entering 6th grade are
under state regulations because of special required to have a one-time Tdap (Tetanus-
circumstances; diphtheria-pertussis) vaccine. Please provide proof
of these vaccinations from your provider’s ofÞce with
• the teacher's college major, whether the teacher has
advanced degrees and, if so, the subject of the a computer printout and doctor or nurse signature.
degrees;
• whether any teacher's assistants or similar
paraprofessionals provide services to your child and,
if they do, their qualification.
Elementary Parents
By Michael Johnson
Please continue saving milk caps, and Box Tops for
Education. Thank you for your time and help!
5Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
CLOSED CAMPUS It is our hope that parents continue to give full
The Bangor School Board has adopted a closed support for the closed campus policy as you have in
campus policy, which provides a safer atmosphere and past years. Penalties for violation of closed campus
stronger student accountability. policy will result in detention for first offense and in-
Closed campus simply means a student cannot school suspension for subsequent violations.
leave campus during noon hour or any time during
the school day. This, of course, implies that students IF PARENTS HAVE A COMPLAINT ABOUT
may not drive or sit in their car any time during the SCHOOL
day. Use of tobacco is not permitted on campus, so If there is a complaint or criticism involving a
students who use tobacco are not permitted to do so student problem, please contact the teacher involved
until they leave school grounds at the end of the day in order that he/she may explain the reasons for his/
or are dropped off from the bus. A Wisconsin law her actions and clarify the situation.
makes possession of tobacco by minors illegal. If after contacting the teacher the problem
Blanket or general excuses written by parents to remains or satisfaction has not been received, contact
either permit students to leave campus, drive their in order: the building principal, and then the district
cars or be a passenger in a car will not be honored. administrator. If it is not resolved at that level, contact
If an urgent need to leave campus arises, parents a school board member who may take it to the board
must contact the principal's office and send a note at a formal meeting.
stating the specific reason, for a specific day as well as Please do not limit your communications with the
why it is essential that their child leave school school to complaints or criticisms; we like to hear
grounds. Frivolous requests will be denied. For good news, too.
example, students may not leave campus to get a
haircut or put gas in their car. If an emergency arises,
COMMUNICATIONS
efforts will be made to contact parents before a
School officials will make every effort to increase
student leaves.
communications with parents. Also, we welcome your
Some students live within walking distance of the
input. Please do not hesitate to call, write or visit with
school and have been accustomed to going home for
our administrators and teachers and arrange to visit
lunch. We plan to continue this practice. The
school through the appropriate principal. The Monroe
guidelines will be the same as past years. They are as
County Herald newspaper publishes school news and
follows:
other information about the schools in the district.
1. Students may walk home (cars are not permitted
for any reason) and must return on time.
BLOOD DRIVES
Tardiness will result in suspension of this
National Honor Society and Student Council will
privilege to eat lunch at home.
host blood drives on October 20th, December 15th,
2. Students may not go to any place other than
March 2nd, and May 12th.
their own home. Any side trips will result in loss
of this privilege.
3. If any abuse of going home for lunch is
discovered, the privilege will be suspended.
4. A special form is required for students who go
home for lunch. This form may be picked up at
the principals' offices.
6Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
SCHOOL FOOD SERVICE PROGRAM
The elementary school and high school/
If you qualify it would help your family and the School
middle school serve lunch and breakfast each day.
District of Bangor in regard to state and federal aids. We
Elementary school breakfast is served from 7:40-8:05
understand if you feel strongly and wish not to apply, and
a.m., high/middle school from 7:30 to 8:00 a.m. The
respect your opinion.
school district has a computerized Lunch Cashier
Please understand you need to reapply for meal
System, which is set up by family. Families make
benefits each year.
payments to their family account, which may be
Due to the new board policy that was adopted to
drawn on from their children in either school.
meet the mandate of the Wisconsin Department of Public
Payments for meals and milk break may be sent to
Instruction, as of July 1, 2017, when a family account
the school district office or sent to school with your
reaches a balance of negative $30, no meals will be
child. Deposits can be made into lunch accounts
served until the account is brought up to date. A copy of
within JMC parent access. Meal prices are as follows:
the policy is available in the District office and is available
Lunch
on the school district website under the District tab and
K-5 $2.85 per meal
Board Policies.
6-12 $3.15 per meal
Adult $4.25 per meal
Elementary School Milk Break
Breakfast
Elementary students will also have a daily milk break.
K-5 $1.55 per meal
This milk costs $15.75 per quarter ($6.30 for 4K students).
6-12 $1.80 per meal
This amount is to be paid to and deducted from the
Adult $2.75 per meal
family lunch account at the beginning of each quarter.
Milk $.50 per carton
Parents are invited to join us for either meal.
Lunch statements indicating family account numbers,
as well as individual student numbers and account
balances will be provided at registration.
Children may also qualify for free meals or for Mandatory Parent Communication and
meals at a reduced price. Please note: Any milk Sportsmanship Seminar
purchased in addition to or in lieu of a school meal
will cost 50 cents, and may be deducted from your
There will be a mandatory Parent Communication and
family account balance.
Sportsmanship Seminar held at Bangor High School on
Sunday, August 8th, 2021, starting at 7:00 p.m. Any
FREE AND REDUCED PRICE MEAL
parents or guardians who have children participating in a
APPLICATION FORMS ARE INCLUDED WITH THIS
fall sport, grades 9-12, are required to attend.
MAILING. Parents need to reapply at the beginning
After the seminar, the parents will attend a meeting
of each school year to continue receiving free &
with each coach of the fall sports to review rules and
reduced price meal benefits.
expectations for the individual sports in which their child
The Bangor School Board asks that you please fill
will be participating. Parents only need to attend one
out an application for free or reduced lunches and
sportsmanship meeting per school year.
breakfasts if you qualify. Some federal and state
If you have any questions please contact Athletic
funds are based upon the number of residents who
Director Paul Laxton at 608-486-5222 or by email at
qualify for free and reduced meals. These funds
plaxton@bangorsd.net.
assist our school district. We have a computerized
system; therefore information is confidential and
children are not identified.
7Bangor School District Newsletter.
Issue #25 Volume #1 Summer 2021-August 4
Attention Home School Families
Affordable Health Insurance Available to Many
Please be sure to complete the Home Based
Bangor School District Families
Private Educational Program form (PI-1206 on the
Wisconsin Department of Public Instruction website:
Does your child have health insurance? Do You?
www.dpi.state.wi.us. Questions about this process
If you answered no to either question, you are not
and form can be directed to the Department of Public
alone. Many families in our community do not have
Instruction at 608-266-5761 or toll free at
health insurance for one, or all family members.
888-245-2732.
Fortunately, BadgerCare Plus now offers an
The public school districts in the state are required
affordable health insurance option to Bangor School
to account for the education of all school-aged
District families!
children in their respective school districts. Thank you
If you or your children do not have insurance
for your assistance in meeting this requirement.
now, you have these options for applying in La
Crosse County:
Go on-line: www.access.wi.gov Scenic Bluffs Senior Citizen Conference Passes are
Call: Lindsey Schwarz-Nichols, La Crosse available in the District Office. These passes are free
County Health Department: (608 785-5841) to citizens 60 years of age and older and are good for
or La Crosse County Economic Support at all conference games.
(608) 784-4357
Visit: La Crosse County Economic Support
Health & Human Services, 1st Floor 300 4th Street
North, LaCrosse ATHLETIC SEASON PASSES, 2021-2022
Family - $80.00
homeenergy+ Adult - $45.00
Energy Assistance Student - $20.00
Weatherization Assistance Sr. Citizen - Free (60 Yrs. & older and taxpayer in
Crisis Assistance ~ Furnace Assistance the school district)
*** Family includes parents, preschool children,
La Crosse County (608) 784-4357 elementary or high school students only (does not
include college students).
Passes are sold at the District OfÞce
NONDISCRIMINATION POLICY
The Bangor School District does not discriminate UPCOMING EVENTS
against pupils on the basis of sex, race, national
origin, ancestry, creed, pregnancy, marital or parental
Please visit our school district website,
status, sexual orientation, or physical, mental,
w w w. b a n g o r. k 1 2 . w i . u s f o r a c t i v i t i e s
emotional or learning disability or handicap in its
education programs or activities. Federal law information.
prohibits discrimination in employment on the basis
of age, race, color, national origin, sex or handicap.
8Bangor School District Staff Last Name First Name Position Ext Direct Dial E-Mail Address School District Business OfÞce Brokopp David District Administrator 202 486-5202 dbrokopp@bangorsd.net Kotek Jody Administrative Secretary 216 486-5216 jkotek@bangorsd.net Reigel Jean ConÞdential Secretary 203 486-5203 jreigel@bangorsd.net Whiteaker Anjie Financial Director 204 486-5204 awhiteaker@bangorsd.net Bangor Elementary School Alvin Andrea Special Education 213 486-5213 aalvin@bangorsd.net Anderson Jeanette Special Education 211 486-5211 jeanderson@bangorsd.net Blount Tara First Grade 271 486-5271 tblount@bangorsd.net Briggs Melissa Kindergarten 268 486-5268 mbriggs@bangorsd.net Brooks Melanie 4K & Intervention 274 486-5274 mbrooks@bangorsd.net Brownell Tami Nurse 208 486-5208 tbrownell@bangorsd.net Burritt Vicki Speech & Language 213 486-5213 vburritt@bangorsd.net Carlson Jeanette Paraprofessional 287 486-5287 jcarlson@bangorsd.net Chaplin Josh Psychologist 207 486-5207 jchaplin@bangorsd.net Crenshaw Joy Paraprofessional 299 486-5299 jcrenshaw@bangorsd.net De Bauche Andrea Art 215 486-5215 adebauche@bangorsd.net Dubanowich Anna Special Education 299 486-5299 adubanowich@bangorsd.net Elsen Matt Custodian 265 486-5265 melsen@bangorsd.net Gamroth Tim Custodian 253 486-5253 tgamroth@bangorsd.net Gerke Debra Fifth Grade 275 486-5275 dgerke@bangorsd.net Gonia-Larkin Kristin Fourth Grade 286 486-5286 kgonialarkin@bangorsd.net Hesselberg Stephanie Cook 214 486-5214 shesselberg@bangorsd.net Huffman Katie First Grade 269 486-5269 khuffman@bangorsd.net Jacobson Jessica Paraprofessional 274 486-5274 jjacobson@bangorsd.net Jacobson Matthew Elementary Guidance 212 486-5212 mjacobson@bangorsd.net Jambois Tara Special Education 297 486-5297 tjambois@bangorsd.net Johnson Michael Elementary Principal 206 486-5206 mjohnson@bangorsd.net Kastenschmidt Jan Head Cook 214 486-5214 jkastenschmidt@bangorsd.net Kenyon Teri Elementary Secretary 205 486-5205 tkenyon@bangorsd.net Koltermann Kathy Paraprofessional 279 486-5279 kkoltermann@bangorsd.net Lamprich Jaimi First Grade 264 486-5264 jlamprich@bangorsd.net
Langrehr Sarah Second Grade 267 486-5267 slangrehr@bangorsd.net Laufenberg Kelli Second Grade 277 486-5277 klaufenberg@bangorsd.net Le Tendre Sally Kindergarten 285 486-5285 slatendre@bangorsd.net Lorenz Michelle Second Grade 263 486-5263 mlorenz@bangorsd.net Martinez Amy Fourth Grade 266 486-5266 amartinez@bangorsd.net Meacham Nicholas Fifth Grade 270 486-5270 nmeacham@bangorsd.net Nicolai Laura Paraprofessional 211 486-5211 lnicolai@bangorsd.net Paisley Dawn Third Grade 272 486-5272 dpaisley@bangorsd.net Pederson Jacob Physical Education 282 486-5282 jpederson@bangorsd.net Peyton Lindsey IMC Director 210 486-5210 lpeyton@bangorsd.net Pickering Rhonda Paraprofessional 211 486-5211 rpickering@bangorsd.net Powers Bridget Kindergarten 296 486-5296 bpowers@bangorsd.net Regan Julie Third Grade 273 486-5273 jregan@bangorsd.net Schilling Dustin Art 215 486-5215 dschilling@bangorsd.net Schulz Melissa Reading Specialist 283 486-5283 mschulz@bangorsd.net Shaw Piper Music 276 486-5276 pshaw@bangorsd.net Steiner Stephanie Paraprofessional 301 486-5301 ssteiner@bangorsd.net Waldenberger Lisa 4K 287 486-5287 lwaldenberger@bangorsd.net Weisse Diane Reading Specialist 267 486-5284 dweisse@bangorsd.net Bangor High School / Middle School Adams Susan Science 239 486-5239 sadams@bangorsd.net Baurichter Carlene HS Social Studies 221 486-5221 cbaurichter@bangorsd.net Bierbrauer Richard Agriculture 241 486-5241 rbierbrauer@bangorsd.net Brownell Tami Nurse 250 486-5250 tbrownell@bangorsd.net Chaplin Josh Psychologist 255 486-5255 jchaplin@bangorsd.net Cook Andrew English 231 486-5231 acook@bangorsd.net Craig Debra Paraprofessional 257 486-5257 dcraig@bangorsd.net Elliott Kristin Cook 249 486-5249 kelliott@bangorsd.net Evenson Michelle Cook 249 486-5249 mevenson@bangorsd.net Freymiller Brittany English 292 486-5292 broscovius@bangorsd.net Goede Norman Custodian 253 486-5253 ngoede@bangorsd.net Grant Todd Special Education 238 486-5238 tgrant@bangorsd.net Harper Michelle Special Education 259 486-5259 mharper@bangorsd.net Horstman Cheri Business Education 234 486-5234 chorstman@bangorsd.net Horstman Melanie HS/MS Secretary 200 486-5200 melhorstman@bangorsd.net
Hurst Andrea MS Math/English 244 486-5244 ahurst@bangorsd.net Johnson Kari MS Math 243 486-5243 kjohnson@bangorsd.net Jones Katie Paraprofessional 238 486-5238 kjones@bangorsd.net Jones Ross Instrumental Music 225 486-5225 rjones@bangorsd.net Kapanke Jane Paraprofessional 259 486-5259 jkapanke@bangorsd.net Klos Aimee MS English 224 486-5224 aklos@bangorsd.net Kratochvill Adam Technology Education 258 486-5258 adkratochvill@bangorsd.net Kravik Kevin Social Studies 262 486-5262 kevkravik@bangorsd.net Kravik Roxanne K12 Tech. Int./Intervent. 290 486-5290 rkravik@bangorsd.net Langrehr Brenda Custodian 253 486-5253 blangrehr@bangorsd.net Laxton Paul Athletic Director 222 486-5222 plaxton@bangorsd.net Laufenberg Jordan Physical Ed./Adaptive 242 486-5242 jlaufenberg@bangorsd.net Lueck Brooke Physical Ed./Health 252 486-5252 blueck@bangorsd.net Lueck Dave Alternative Learning 240 486-5240 dlueck@bangorsd.net Lyga Andrew HS/MS Science 293 486-5293 alyga@bangorsd.net Lyga Heidi Spanish 254 486-5254 hlyga@bangorsd.net Magnuson John Computer Technician 246 486-5246 jmagnuson@bangorsd.net Miller James MS Math/Science 294 486-5294 jamiller@bangorsd.net Muellenberg Rick MS/HS Principal 201 486-5201 rmuellenberg@bangorsd.net Peterson Christina Special Education 228 486-5228 cp.gianunzio@bangorsd.net Gianunzio Peyton Lindsey IMC Director 257 486-5257 lpeyton@bangorsd.net Radke Carrie Paraprofessional 228 486-5228 cradke@bangorsd.net Rampetsreiter Dan MS Social Studies 227 486-5227 drampetsreiter@bangorsd.net Regan Matt MS Science 226 486-5226 mregan@bangorsd.net Schilling Dustin Art 236 486-5236 dschilling@bangorsd.net Schmitz Emily Math 237 486-5237 eschmitz@bangorsd.net Schulz Hannah Guidance Counselor 217 486-5217 hschulz@bangorsd.net Stange Michael Maintenance Supervisor 253 486-5253 mstange@bangorsd.net TBD Family & Consumer Ed. 232 486-5232 Theurer Julie Math 223 486-5223 jtheurer@bangorsd.net Thummel Brittany Vocal Music 235 486-5235 bthummel@bangorsd.net
Bangor School District Staff
Bus Drivers General Route Area
Hwy. 33, Hwy. 162 South, Cty. JB, Dutch Creek,
John Hundt
Cty. B toward West Salem.
Hwy. 162 North, Burns, North end of Village of
Dale Johnson Bangor
Cty. E, Cty. DE, Bosshard Addition (Hansen’s IGA
Jeanette Carlson
area)
Jewett Rd., Big Creek Rd., Addition at end of
Mark Hansen Herman Rd., Cty. J (North of Rockland), Cty. B
(Prairie Rd.)
Jackpot Ave., Hummingbird Heights, Rock St.,
Ron Copher
Cty. U, Meadowview Addition (Bangor.)
Cty. J & Y South of Rockland, Streets by the
Dennis Piper
Rockland water tower addition.
Kale Rd., Commercial, Campbell, Main, Center,
Oak and Portland streets in Rockland, St. Paul’s
Shawn Stach Church parking lot, Village Inn area.
Diane Rasmussen Small Bus
Rod Nicolai Van
12Bangor Elementary School Student Supply List 2021-2022
4K/Early Childhood Grade One
• 1 Red & blue Kinder Rest Mat 19”x45” (labeled) • 2 boxes Crayola Classic wide markers
• 1 Red poly folder - (without the 3 prongs) • 2 boxes of 24 Crayola crayons
• 2 Small glue sticks - Elmer’s washable • 12 glue sticks
disappearing purple • 1 pair Fiskars blunt scissors
• 1 Backpack - large enough for snow clothes in • 3 large erasers
the winter (labeled) • 1 pencil box (Spacemaker type)
• 3 boxes of 8 count crayons - regular size • 24 Ticonderoga pencils (sharpened)
(no jumbo please) • 2 black Expo dry erase fine tip markers
• 1 set of child size headphones (not ear buds) • 2 2-pocket folders
labeled • 1 yellow wide-ruled spiral notebook
• 3 containers of disinfecting wipes • 1 red wide-ruled spiral notebook
• 1 item for snack (crackers, goldfish, dry cereal, • 1 3-ring 1-inch binder
etc.) • 1 set headphones (no ear buds please)
• 1 change of clothes (labeled and in a ziplock • 1 box cracker/pretzels for snack
bag) • Girls-1 box quart baggies (zipper slider closure)
• Girls-1 package of napkins • Boys-1 box gallon baggies (zipper slider
• Boys-1 box of Kleenex closure)
• Play-Doh – 4 pack • 2 containers disinfecting wipes
• 1 backpack
• Tennis shoes are needed on P.E. days
Grade Two
• 12 #2 plain pencils (sharpened)
• 1 pair headphones
Kindergarten • 3-pack of 3” square Post-it Notes
• 1 set of headphones • 2 glue sticks
• 1 rest mat-we recommend Kinder Mat 19”x45” • 3 wide-ruled spiral notebooks (labeled)
• 1 vinyl or cloth zippered pencil case • 5 plain pocket folders-1 red, 1 green, 1 yellow,
• 2 boxes of 8 crayons (basic colors) regular size 1 blue, and 1 choice (labeled)
• 2 boxes of 8 washable thin line markers (basic • 1 box of 8 classic washable markers (labeled)
colors) • 1 box of 24 crayons (labeled)
• 2 boxes of 8 washable wide line markers (basic • Pack of ballpoint pens
colors) • 1 box of 12 colored pencils (labeled)
• 24 glue sticks • 4 black fine point Expo Dry Erase markers
• 1 2-pocket folder • 1 vinyl or cloth zippered pencil case
• 3 containers of disinfecting wipes • 2 small spiral notebooks (3” x 5”-top bound
• 2 large boxes of Kleenex spiral notebooks, labeled)
• 1 package of napkins • Tennis shoes for P.E. days
• Girls-1 box quart baggies (zipper slider closure) • Backpack
• Boys-1 box gallon baggies (zipper slider • 2 packages of baby wipes (refills are fine)
closure)
• 1 box of crackers/pretzels for snack
• 1 backpack (must be brought daily
• Tennis shoes are needed for P.E.Bangor Elementary School Student Supply List 2021-2022
Grade Three Grade Five
• 1 pocket folder • Backpack
• 4 red plain pocket folders • 1 yellow highlighter
• 4 wide-ruled spiral notebooks • 24 #2 pencils-sharpened
• 2 boxes of 24 crayons • 2 large glue sticks
• 24 #2 yellow pencils (Ticonderoga only-can be • 1 large eraser
found at office supply stores) • 12 colored pencils
• 1 backpack (labeled with child’s name) • 1 pencil box
• 3 boxes of 12 colored pencils (Crayola only) • 1 ruler-standard-metric
• 1 canister of Lysol or Clorox sanitizing wipes • 1 scissors
• 1 set of headphones-no ear buds please • 1 set of headphones
• 2 packs of Post-it Notes (3x3 size, Not Super- • 4 wide-ruled spiral notebooks-1 red, 1 blue, 1
Sticky) yellow, and 1 black
• Snack: 1 box of crackers/pretzels • 1 wide-ruled green 3-subject spiral notebook
• 3 packs of sugar-free gum • 1 6-compartment, heavy duty, expanding Þle
• NO mechanical pencils, pencil boxes, markers, • 3 pens (black or blue ink)
pens, pencil sharpeners or scissors • 1 pack wide-ruled, loose leaf notebook paper
• 1 pack of Post-it Notes (3x3 square)
DO NOT LABEL INDIVIDUAL ITEMS • 3 black extra Þne Sharpie markers
Place all items in one bag labeled with your child’s • $4.00 for assignment notebook
name. You may bring it to Open House
LABEL ALL ITEMS
Grade Four
• 1 ball-point pen (red or blue ink)
• 2 wide-ruled spiral notebooks
• 1 pack wide-ruled, loose leaf notebook paper
• 6 pocket folders-1 blue, 1 red, 1 yellow, 1 green,
1 purple, and 1 plastic coated folder
• 1 box colored pencils-Crayola only
• 1 box of 24 crayons-Crayola only
• 1 dry erase marker-black
• 1 yellow highlighter
• 1 package washable markers
• 24 #2 yellow pencils (Ticonderoga only,
sharpened)
• 1 canister of Lysol sanitizing wipes
• 1 pack 4x6 index cards, yellow or white, lined
• 1 set of headphones (no ear buds)
• 1 pencil box
• 1 backpack
• 1 pack Post-It notes (Not Super Sticky)
• $4.00 for assignment notebook
• 1 box crackers or 1 bag of pretzels
• 3 packs of sugar-free gum
• NO pencil sharpeners or scissors
Please label items and bring to Open House
13Bangor Middle School Student Supply List 2021-2022
Study Materials Family and Consumer Education (FACE)
We encourage students in grades 6-8 to bring the Supply list for sewing projects will be sent home
following materials to assist them with organization when needed for class
and their preparation to study:
• Pens
• Pencils
• Red pen Physical Education
• 2 highlighters • Personal hygiene supplies
• Glue stick ✓ deodorant/antiperspirant
• Scissors • Gym clothes
• Colored pencils ✓ School appropriate, knee-length shorts
• Markers
✓ T-shirts
• Loose leaf paper
✓ Sweatpants
• 5 Notebooks
• 5 Folders ✓ Socks
• Earbuds ✓ Athletic shoes
No Axe body spray
Math
• 3-subject notebook
English
• 3-subject notebook
Spanish
• Spanish Dictionary
Art
• 9 x 12 ring-bound sketchbook
• 12 #2 pencils
Band
• Box of 10 reeds for woodwind instruments
• Cleaning swabs for woodwind instruments
• Valve oil, cleaning snake for brass instruments
• Drum sticks for percussionBangor High School Student Supply List 2021-2022
Study Materials Health 9
We encourage students in grades 9-12 to bring the • Notebook
following materials to assist them with organization • Folder
and their preparation to study: Science Courses with Mrs. Adams
• 3-ring binder Chemistry, Physics, Physical Science (9th Gr.)
• 6 folders with pockets • Notebook
• Plastic holder for pencils, pens, etc. • Folder
• Writing materials (paper, pencils, pens, etc.) • Scientific calculator (does not need to be
• Ear buds graphing)
Social Studies Science Courses with Mr. Lyga
World History, Political Science, Sociology, Biology
Psychology, U.S. History, AP History, • 3-subject notebook
Economics • Folder
• 1 notebook and folder for each subject Anatomy & Physiology
• Pencils • 3-subject notebook
• Black or blue pens • 3-ring binder
• Colored pencils • Colored pencils
• Glue stick Art
English Art Survey & Drawing
English 9, English 10, English 11, English 12 • 9 x 12 ring-bound sketchbook
• 3-subject notebook • 12 #2 pencils
• Folder Painting & Ceramics
• Pencils • 12 #2 pencils
• Highlighters Family and Consumer Education (FACE)
• Post-it notes Students taking sewing classes at the high school
• Ear buds level will need to purchase their own materials for
Creative Writing, Argument and Debate, class.
Career Communications, and Contemporary Spanish
Literature • Notebook
• Notebook • Folder
• Folder • Spanish Dictionary
• Pencils Physical Education
• Ear Buds • Personal hygiene supplies
• Highlighters (deodorant/antiperspirant)
AP English • Gym clothes (school appropriate, knee-length
• 1” or larger 3-ring binder shorts, t-shirts, sweatpants, socks, athletic
• Loose leaf paper shoes)
• 6-7 binder dividers • No Axe body spray
• Folder
Band
• Pencils
• Box of 10 reeds for woodwind instruments
Math
• Cleaning swabs for woodwind instruments
• Pencils
• Valve oil, cleaning snake for brass instruments
• Scientific calculator
• Drum sticks for percussion
• Notebook
• 3-ring binderFREQUENTLY ASKED QUESTIONS ABOUT FREE AND REDUCED PRICE
SCHOOL MEALS FOR SCHOOL YEAR 2021-22
Dear Parent/Guardian:
Children need healthy meals to learn. The offers healthy meals every school day. Breakfast costs $0; lunch
costs $0. Your children may qualify for free meals or for reduced price meals. Reduced price is $0 for breakfast and $0 for lunch. This
packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common
questions and answers to help you with the application process.
1. WHO CAN GET FREE OR REDUCED PRICE MEALS?
• All children in households receiving benefits from FoodShare, the Food Distribution Program on Indian
Reservations (FDPIR), or W-2 cash benefits are eligible for free meals, when listed on the application.
• Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals.
• Children participating in their school’s Head Start program are eligible for free meals.
• Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.
• Children may qualify to receive free or reduced price meals if your household’s income is at or below the limits on
the Federal Income Eligibility Guidelines.
FEDERAL ELIGIBILITY INCOME CHART For School Year 2021-2022
Household size Yearly ($) Monthly ($) Weekly ($)
1 23,828 1,986 459
2 32,227 2,686 620
3 40,626 3,386 782
4 49,025 4,086 943
5 57,424 4,786 1,105
6 65,823 5,486 1,266
7 74,222 6,186 1,428
8 82,621 6,886 1,589
Each additional person: 8,399 700 162
2. HOW DO I KNOW IF MY CHILDREN QUALIFY AS HOMELESS, MIGRANT, OR RUNAWAY? Do the members of your household
lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your
family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or
household? If you believe children in your household meet these descriptions and have not been told your children will get
free meals, please call or e-mail David Brokopp, 608-486-5202, dbrokopp@bangorsd.net.
3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application
for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required
information. Return the completed application to: Jody Kotek, 700 10 th Avenue South, PO Box 99, Bangor, WI 54614,
608-486-5216.
4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY
APPROVED FOR FREE OR REDUCED PRICE MEALS? Please read the letter you received carefully and follow the instructions. If
your letter indicated you qualify for free meals, then no application is needed. If any children in your household were missing
from your eligibility notification, contact Jody Kotek, 700 10 th Avenue South, PO Box 99, Bangor, WI 54614, 608-486-
5216, jkotek@bangorsd.net immediately.If your household was notified it qualified for reduced price meals, we encourage
you to complete an application to potentially qualify for free meals based on household size and income.
5. DO I NEED TO FILL OUT AN APPLICATION IF MY CHILD ATTENDS A SCHOOL PARTICIPATING IN THE SEAMLESS SUMMER
OPTION (SSO) OR COMMUNITY ELIGIBILITY PROVISION SCHOOL (CEP)? If your child attends a school that participates in SSO
OR CEP, receipt of free breakfast and lunch meals does not depend on returning this application. However, this information is
necessary for other programs and may be used to determine if your household is eligible for additional benefits.6. CAN I APPLY ONLINE? Yes! You are encouraged to complete an online application instead of a paper application if you are
able. The online application has the same requirements and will ask you for the same information as the paper application.
Visit ǣȀȀǤ Ǥ Ȁ ȀǤ to begin or to learn more about the online application process.
Contact Jody Kotek, 700 10 th Avenue South, PO Box 99, Bangor, WI 54614, 608-486-5216, jkotek@bangorsd.net if you
have any questions about the application process.
7. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is
only good for that school year and for the first few days of this school year, through October 14, 2021 or when a new
eligibility is determined. You must submit a new application unless the school told you that your child is eligible for the new
school year. If you do not submit a new application that is approved by the school or you have not been notified that your
child is eligible for free meals, your child will be charged the full price for meals.
8. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or
reduced price meals, but it is based on income. Please submit an application.
9. MY CHILD(REN) QUALIFIES FOR BADGERCARE PLUS OR MEDICAID. CAN MY CHILD GET FREE MEALS? Children with
BadgerCare Plus, Medicaid, or subsidized insurance may be eligible for free or reduced price meals, but it is based on
household income and household size. Please submit an application to determine if your household qualifies.
10. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you
report.
11. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example,
children with a parent or guardian who becomes unemployed or experience a financial hardship may become eligible for free
and reduced price meals if the household income drops below the income limit.
12. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also
may ask for a hearing by calling or writing to Julie Meyers, School Board President, W2286 Hwy 16, Bangor, WI 54614,
608-386-9908, jmeyers@bangorsd.net.
13. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other household
members do not have to be U.S. citizens to apply for free or reduced price meals.
14. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally
make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per
month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a
job or had your hours or wages reduced, use your current income.
15. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not receive some types of
income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in
the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when
leaving income fields blank, as we will assume you meant to do so.
16. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash bonuses must be reported
as income. If you get any cash value allowances for off-base housing, food, or clothing, it must also be included as income.
However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as
income. Do not include any combat pay resulting from deployment as income.
17. WHAT IF THERE IS NOT ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a
separate piece of paper and attach it to your application.
18. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for
FoodShare or other assistance benefits, contact your local assistance office or call 1-800-362-3002.
If you have other questions or need help, call 608-486-5216.
Sincerely,
David Brokopp, SuperintendentHOW TO APPLY FOR FREE AND REDUCED PRICE SCHOOL MEALS for 2021-22 School Year
Please use these instructions to help you fill out the application for free or reduced price school meals. You only need to submit one application per household, even if your
children attend more than one school in the School District of Bangor. The application must be filled out completely to certify your children for free or reduced price school
meals. Please follow these instructions in order. If at any time you are not sure what to do next, please contact Jody Kotek, 608-486-5216, jkotek@bangorsd.net.
If your child attends a school participating in the Seamless Summer Option or the Community Eligibility Provision School (CEP), receipt of free breakfast and lunch meals does not
depend on returning this application; however, this information is necessary for other programs.
PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY.
STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS, CHILDREN, AND STUDENTS UP TO AND INCLUDING GRADE 12
Tell us how many infants, children, and school students live in your household. They do NOT have to be related to you to be a part of your household.
Who should I list here? When filling out this section, please include ALL members in your household who are:
• Children grades 12 or under AND are supported with the household’s income; and
• In your care under a foster arrangement, or qualify as homeless, migrant, or runaway youth, or enrolled in a Head Start program.
A) List each child’s name. Print each child’s B) Enter the grade and the name C) Do you have any foster children? If any children D) Are any children homeless, migrant,
name. Use one line of the application for each of the school the child attends or listed are foster children, mark the “Foster Child” box runaway or enrolled in a Head Start
child. When printing names, write one letter mark n/a if not in school. next to the children’s names. If you are ONLY applying program? If you believe any child listed in
in each box. Stop if you run out of space. If for foster children, after finishing STEP 1, go to STEP 4. this section meets this description, mark
there are more children in household than Foster children who live with you may count as the “Homeless, Migrant, Runaway or
lines on the application, attach a second piece members of your household and should be listed on Head Start” box next to the child’s name
of paper with all required information for the your application. If you are applying for both foster and complete all steps of the application.
additional children. and non-foster children, go to step 3.
STEP 2: DO ANY HOUSEHOLD MEMBERS CURRENTLY PARTICIPATE IN FoodShare, W-2 Cash Benefits OR FDPIR?
If anyone in your household (including you) currently participates in one or more of the assistance programs listed below, your children are eligible for free school meals:
• The Supplemental Nutrition Assistance Program (SNAP) or FoodShare.
• Temporary Assistance for Needy Families (TANF) or W-2 Cash Benefits.
• The Food Distribution Program on Indian Reservations (FDPIR).
A) If no one in your household participates in any of the B) If anyone in your household participates in any of the above assistance programs:
above listed programs: • Write a case number and name of the assistance program you or any member of the household participates in
• Leave STEP 2 blank or check “No” and go to STEP 3. for FoodShare, W-2 Cash Benefits, or FDPIR. You only need to provide one case number. If you participate in
one of these programs and do not know your case number, contact your case worker. Medicaid and
BadgerCare case numbers do NOT qualify for free or reduced price meals.
• Go to STEP 4.
STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS
How do I report my income?
• Use the charts titled “Sources of Income for Children” and “Sources of Income for Adults,” printed on the back side of the application form, to determine if your household
has income to report.
• Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents. Gross income is the total income received before taxes. Many people
think of income as the amount they “take home” (listed as “net pay” on paycheck stub) and not the total, “gross” amount. Make sure that the income you report on this
application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay.STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS
• Write a “0” in any fields where there is no income to report. Any income fields left empty or blank will also be counted as a zero. If you write ‘0’ or leave any fields blank, you
are certifying (promising) that there is no income to report. If local officials suspect that your household income was reported incorrectly, your application will be
investigated.
• Mark how often each type of income is received using the boxes to the right of each field.
3.A. REPORT INCOME EARNED BY CHILDREN
A) Report all income earned or received by children. Report the combined gross income for ALL children listed in STEP 1 in your household in the box marked “Child Income.”
Only count foster children’s personal income if you are applying for them together with the rest of your household.
What is Child Income? Child income is money received from outside your household that is paid DIRECTLY to your children. Many households do not have any child income.
3.B. REPORT INCOME EARNED BY ADULTS
List adult household members’ names.
• Print the name of each household member in the boxes marked “Name of Adult Household Members (First and Last).” When filling out this section, please include ALL adult
members in your household who are living with you and share income and expenses, even if they are not related and even if they do not receive income of their own.
• Do NOT include:
o People who live with you but are not supported by your household’s income AND do not contribute income to your household.
o Infants, children and students already listed in STEP 1.
C) Report earnings from work. Report all total gross income D) Report income from public assistance/child E) Report income from
(before taxes) from work in the “Earnings from Work” field on support/alimony/SSI/VA benefits. Report all income that applies in pensions/retirement/all other income.
the application. This is usually the money received from working the “Public Assistance/Child Support/Alimony” field on the Report all income that applies in the
at jobs. If you are a self-employed business or farm owner, you application. Do not report the cash value of any public assistance “Pensions/Retirement/Social Security/All Other
will report your net income. benefits NOT listed on the chart. If income is received from child Income” field on the application.
support or alimony, only report court-ordered payments. Informal
What if I am self-employed? Report income from that work as a but regular payments should be reported as “other” income in the
net amount. This is calculated by subtracting the total operating next part.
expenses of your business from its gross receipts or revenue.
F) Fluctuating Income. For seasonal workers and others whose G) Report total household size. Enter the total number of H) Provide the last four digits of your Social
income fluctuates and usually earn more money in some months household members in the field “Total Household Members (Children Security Number (SSN). An adult household
than others. In these situations, project the annual rate of and Adults).” This number MUST be equal to the number of member must enter the last four digits of their
income and report that. This includes workers with annual household members listed in STEP 1 and STEP 3. If there are any SSN in the space provided. You are eligible to
employment contracts but may choose to have salaries paid over members of your household that you have not listed on the apply for benefits even if you do not have a
a shorter period of time; for example, school employees. application, go back and add them. It is very important to list all SSN. If no adult household members have a
household members, as the size of your household affects your SSN, leave this space blank and mark the box to
eligibility for free and reduced price meals. the right labeled “Check box if no SSN.”
STEP 4: CONTACT INFORMATION AND ADULT SIGNATURE
An adult member of the household must sign the application. By signing the application, that household member is promising that all information has been truthfully and
completely reported. Before completing this section, please also make sure you have read the privacy and civil rights statements on the back of the application.
A) Provide your contact information. Write your current B) Print or sign your name. C) Return completed D) Share children’s racial and ethnic identities
address in the fields provided if this information is available. The adult filling out the form to: School District (optional). On the back of the application, we ask you
If you have no permanent address, this does not make your application must print or sign of Bangor, 700 10th to share information about your children’s race and
children ineligible for free or reduced price school meals. their name in the signature Avenue South, PO Box ethnicity. This field is optional and does not affect your
Sharing a phone number, email address, or both is optional, box. 99, Bangor, WI 54614 children’s eligibility for free or reduced price school
but helps us reach you quickly if we need to contact you. meals.You can also read
