html_templates.html

<h1>Program Benefits</h1>

<h2>How it works</h2>

<ul>
<li>The US Department of Agriculture (USDA) provides schools with funding for low-cost, healthy meals</li>
<li>Schools must prove that meals meet federal nutrition standards</li>
<li>Funds may be used to cover food, administration, and staffing costs</li>
<li>Participating schools can also receive donated commodity food from the USDA</li>
</ul>

<h2>Why should my student sign up?</h2>
<ul>
<li>Qualified students get access to a balanced, nutritious lunch that includes whole grains, fruits, vegetables and milk</li>
<li>Better food means better grades! Well balanced nutrition improves academic performance and concentration.</li>
<li>Teaching students about good nutrition prepares them to stay healthier in life.</li></ul>

<h2>Schools and programs benefit too</h2>
<ul>
<li>Having students sign up means cash reimbursements for schools</li>
<li>Funds wellness policies to help schools address obesity problems and promote physical activity</li>

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<hr>

<h2>Do you currently participate in any other government program?</h2>

<input type="checkbox" name="govt_type" value="SNAP"> SNAP<br>
<input type="checkbox" name="govt_type" value="TANF" checked> TANF<br>
<input type="checkbox" name="govt_type" value="FDPIR" checked> FDPIR<br>
<input type="checkbox" name="govt_type" value="NONE" checked> NONE<br>


<!--When SNAP, TANF, FDPIR checked populated case number question. Yes then enter case number, No then text-->

<br>
<h2>Do you know your case number?</h2>
<input type="radio" name="case" value="Yes"> Yes<br>
<input type="radio" name="case" value="No"> No<br>

Please contact xxx-xxx-xxxx to receive your case number.

Case Number<br>
<input type="text" name="casenumber" placeholder="XX-XXX-XX-XXX(XXX)"><br><br>

<hr>

<h2>What is your income information?</h2>

<p>Each person who makes money must be listed. If they have multiple sources of income, please add each source of income next to their name.</p>


First name<br>
<input type="text" name="firstname"><br>
MI<br>
<input type="text" name="middleinitial"><br>
Last name<br>
<input type="text" name="lastname"><br>


<hr>

<h2>What are the last four digits of the Social Security Number of the primary wage earner or other adult household member?</h2><br>

XXX-XX-<input type="text" name="ssn"><br><br>

<input type="checkbox" name="no_ssn" value="NULL" checked> No SSN<br>


<hr>

<h2>What is your contact information?</h2>

If you are homeless, you can add a previous, family/friend's, or your shelter's address.<br><br>


Street Address<br>
<input type="text" name="street_address"><br>
Apt. #<br>
<input type="text" name="apt_num"><br>
City<br>
<input type="text" name="city"><br>
State<br>
<input type="text" name="state"><br>
Zip Code<br>
<input type="text" name="zip_code"><br>
Email Address<br>
<input type="text" name="email"><br>
Phone Number<br>
<input type="text" name="phone"><br>
Your First Name<br>
<input type="text" name="firstname"><br>
MI<br>
<input type="text" name="middleinitial"><br>
Last Name<br>
<input type="text" name="lastname"><br>

<br><br><br><br>
Enter your initials to e-sign<br>
<input type="text" name="initials"><br>