To ensure maximum funding for your students’ school, we must collect this completed form from all households. Use these directions to complete the Education Benefit Form for San Ysidro School District. Complete using only blue or black ink.

Step 1: Please list each student attending a school within the SYSD. Legibly print the student date of birth, first and last name, grade and school name.

Step 2: Count the total number of people living in your home and identify the total gross monthly income range.

Who should I include in “People Living in Home”? 

You must include yourself and all people living in your household, related or not (for example, children, grandparents, other relatives, or friends) who share income and expenses. If you live with other people who are economically independent (for example, who do not share income with your children, and who pay a pro-rated share of expenses), do not include them.

What is included in “Total Monthly Income”? 

Total Monthly Income includes all of the following:

• Gross earnings from work: Use your gross income, not your take-home pay. Gross income is the amount earned before taxes and other deductions. This information can be found on your pay stub or if you are unsure, your supervisor can provide this information. Net income should only be reported for self-owned business, farm, or rental income.

• Welfare, Child Support, Alimony: Include the amount each person living in your household receives from these sources, including any amount received from CalWORKS.

• Pensions, Retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits: include the amount each person living in your household receives from these sources.

• All other Income: Include worker’s compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income received. Do not include income from CalFresh, WIC, federal education benefits and foster payments received by your household.

• Military Housing Allowances and Combat Pay: Include off-base housing allowances. Do not include Military Privatized Housing Initiative or combat pay.

• Overtime Pay: Include overtime pay ONLY if you receive it on a regular basis.

How do I report income for pay received on a monthly, twice per month, bi-weekly, and weekly basis?

• Determine each source of household income based on above definitions. Households that receive income at different time intervals must calculate their income as follows:
• If paid monthly – Fill in the correct range
• If paid twice per month, multiply total pay by 2
• If paid bi-weekly (every two weeks), multiply total pay by 26 and divide by 12
• If paid weekly, multiply total pay by 4.33
• Add all annualized pay together, divide by 12 to determine the total monthly household income entered in Step 2.

If your income changes, include the wages/salary that you regularly receive. For example, if you normally make $1000 each month, but you missed some work last month and made $900, put down that you made $1000 per month. Only include overtime pay if you receive it on a regular basis. If you have lost your job or had your hours or wages reduced, enter zero or your current reduced income.

For additional information on People Living in Home and Total Gross Monthly Income, please see the Eligibility Manual for School Meals on the U.S. Department of Agriculture Guidance and Resource Web page at https://www.fns.usda.gov/cn/guidance-and-resources

Step 3: Please print the first and last name of the parent or guardian in the house. This parent or guardian must also sign this form where indicated. Include today’s date.

Submit this form by turning it in to your school site office or the SYSD Business Office located at 4350 Otay Mesa Rd. San Ysidro, ca 92173.

For additional information or any questions, Please contact SYSD Business Office at 4350 Otay Mesa Rd. San Ysidro, ca 92173, (619) 428-4476 Ext. 3006.