Note: Please make sure all required information is completed or your form submission will not be forwarded. Question Title * 1. Contact Person's Information Name* E-mail* Phone* Cell Phone* Name E-mail Phone Cell Phone Question Title * 2. Site Information Site Name* Site Address* City* State* County* Site Phone* Site Fax Question Title * 3. Type of Site (select one)* Recreational School Camp (Overnight) Church Day Care Migrant Homeless College Other Question Title * 4. What type of meals do you plan to serve? (No more than two, unless the site is an overnight camp or migrant site, in which three meals are allowed.) Note: Local sponsors may not offer all meal types. Sites cannot offer both Lunch and Supper. Breakfast AM Snack Lunch PM Snack Supper Question Title * 5. Does your organization have proof of 501c3 federal tax exempt (non-profit) status?* Yes No Question Title * 6. Does site have kitchen facilities (not always required)? Yes No Question Title * 7. Will there be organized activities at the site (not always required)? Yes No Question Title * 8. Estimated number of Children the site would serve (Please make as realistic an estimate as possible.) Minimum* Maximum* Question Title * 9. For the estimated number of children does the site have: Yes No Don't Know Shelter for inclement weather? Shelter for inclement weather? Yes Shelter for inclement weather? No Shelter for inclement weather? Don't Know Adequate storage for prepared or delivered food? Adequate storage for prepared or delivered food? Yes Adequate storage for prepared or delivered food? No Adequate storage for prepared or delivered food? Don't Know Storage space for records at the site? Storage space for records at the site? Yes Storage space for records at the site? No Storage space for records at the site? Don't Know Adequate refrigeration? Adequate refrigeration? Yes Adequate refrigeration? No Adequate refrigeration? Don't Know Access to a telephone? Access to a telephone? Yes Access to a telephone? No Access to a telephone? Don't Know Done