| Applications |
School Lunch Medi-Cal Application, Multi-Child Prototype (DOC) 97 KB
California Department of Education
2007
These multi-child school lunch application prototypes were developed by the California Department of Education for use by schools implementing Express Enrollment.The application includes language referring to Health Kids. If your county does not have a program the language should be deleted.
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School Lunch Medi-Cal Letter to Household, Prototype (DOC) 66 KB
California Department of Education
2007
These school lunch program letters to household were approved by the California Department of Education for use by schools implementing Express Enrollment.
Spanish Version
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Memorandum of Understanding, Prototype (DOC) 81 KB
California Department of Health Services
2005
The California Department of Health Services developed this sample Memorandum of Understanding (MOU). A school district and county must develop a MOU if implementing Express Enrollment.
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Express Enrollment Notification to Parents, Enrolled in Medi-Cal/Healthy Families (DOC) 23 KB
The Children's Partnership
2005
This sample letter developed by the Children's Partnership is available for use by school districts to notify families with children already in Medi-Cal/Healthy Families of the child's ineligibility for Express Enrollment.
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Express Enrollment Notification to Parents, Reduced-Price Children (DOC) 28 KB
The Children’s Partnership
2005
This sample letter developed by The Children’s Partnership is available for use by school districts to notify families with children eligible for reduced-price meals of the child’s ineligibility for Express Enrollment.
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Express Enrollment Notification to Parents, Application Status (DOC) 24 KB
The Children's Partnership
2005
This sample letter developed by The Children’s Partnership is available for use by school districts to notify families of their child’s application status.
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School Lunch Medi-Cal Application Insert, no Healthy Kids (DOC) 60 KB
The Children's Partnership
2005
This sample information insert developed by The Children’s Partnership describes Express Enrollment and can be included with the school lunch application. This insert is for counties that do not have a Healthy Kids program.
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Notice and Supplemental Form for Express Enrollment Applicants, MC 368 (DOC) 76 KB
State of California
2005
Counties are required to send this official state document, called MC 368, to families applying for Express Enrollment so they can complete the application process.
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Important Information for Medi-Cal Applicants, MC 368a (PDF) 32 KB
State of California
2003
This official state document, called MC 368A describes a person’s rights, responsibilities and declaration under the Medi-Cal program. Counties must send this form to families applying for Express Enrollment.
Spanish Version
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