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APPLICATION-AGREEMENT-POLICY STATEMENT - dpi wi Doc 2026

The document outlines the application, agreement, and policy statement for the Wisconsin School Day Milk Program, which provides free milk to eligible children in PreK-5 schools. It details the responsibilities of the Wisconsin Department of Public Instruction and participating School Food Authorities, including eligibility criteria, reimbursement procedures, record-keeping requirements, and compliance with civil rights regulations. The program aims to ensure that children from low-income households receive one half-pint of milk each school day while maintaining their anonymity and providing a fair hearing process for eligibility disputes.

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Click ‘Get Form’ to open the APPLICATION-AGREEMENT-POLICY STATEMENT in our editor.
Begin by filling out the 'APPLICATION' section. Enter the Legal Name of the School Food Authority (SFA), Agency Code, and complete the address fields including Street, City, State, and ZIP.
Provide details for the Authorized Representative and Claim Preparer. Include their names, email addresses, and telephone numbers as required.
Indicate the type of School Food Authority by selecting from options such as Public or Private Nonprofit. Specify the number of schools administered and enter the effective date of this application.
Proceed to the 'AGREEMENT' section. Review and ensure compliance with all terms outlined regarding reimbursement and service obligations.
In the 'POLICY STATEMENT FOR FREE MILK ELIGIBILITY', confirm your understanding of responsibilities related to providing free milk to eligible children.
Finally, list participating schools in Schedule A by entering each school's name and address accurately before submitting your completed form.

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