FFVP Alternate Site Waiver Request Form for SY 2020-2021

USDA has approved the FFVP Alternate Site waiver for SY20-21 in Arizona. This waiver allows State agencies to approve SFAs participating in FFVP to serve FFVP foods at sites that are not elementary schools through June 30, 2021. This may be used in combination with the parent pickup waiver, to allow parent pickup of FFVP foods at sites that are not elementary schools.

SFAs must submit this form to provide details on how they will maintain accountability and program integrity while distributing FFVP at alternate sites. SFAs must submit this form once for SY 20-21 for each alternate site where FFVP will be served. The electronic form must be submitted before the SFA implements FFVP service at the alternate site.

Question Title

* 1. Date service at the Alternate Site will begin:

Date (MM/DD/YYYY)

Date

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* 2. SFA Name

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* 3. Operator First and Last Name:

Question Title

* 4. Operator Title:

Question Title

* 5. Alternate Site Information:

Name of Alternate Site:

Alternate Site Address

City/Town

State/Province

ZIP/Postal Code

FFVP Alternate Site Waiver Request Form for SY 2020-2021

Question Title

* 1. Date service at the Alternate Site will begin:

Question Title

* 2. SFA Name

Question Title

* 3. Operator First and Last Name:

Question Title

* 4. Operator Title:

Question Title

* 5. Alternate Site Information:

Question Title

* 6. Reason FFVP service will be provided at this Alternate Site: