Nourish 282
Food Assistance Program

Enrollment Form

The Nourish 282 Food Assistance Program provides monthly support to families in the St. Anthony/New Brighton School District (MN ISD 282) who could use help providing food stability in their household. Nourish 282 provides a $20 grocery store gift card per month, per child enrolled in this program, with a family cap of $100 per month. Example: 1 student, $20 gc, 3 students, $60 gc.

If you are currently enrolled and receiving assistance, you must fill out this form to maintain your family's enrollment in this program. Families just enrolling, please also fill out the form below.

Gift cards are distributed on the first Friday of each month, a representative from Nourish 282 will contact you via email when cards are ready. Current enrollment period is for Summer 2020 through the 2020-21 School Year.

Contact Julie Pierce directly (info@nourish282.com) with questions.

Question Title

* 1. Parent/Guardian Name

Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Children in Household
Children 0-1 year, please list 'grade' as infant
Children 1-5 years, please list 'grade' as pre-k

Child's Name, Age, Grade

Question Title

* 3. Once students return to school, gift cards can be picked up through your child's school. Please choose which school you prefer to pick up your gift cards.

Community Services Desk

Wilshire Park Elementary

SAMS (St. Anthony Middle School)

SAVHS (St. Anthony Village High School)

Other (I am unable to pick up). Please explain why.

Question Title

* 4. Would you prefer your gift cards be from Aldi or Cub?

Aldi

Cub

Question Title

* 5. How many people reside in your household? (adults and children)

Question Title

* 6. Which of the following languages would you prefer to receive written communication in? (Please select all that apply.)

Amharic

English

French

Japanese

Spanish

Tibetan

Other (please specify)

Question Title

* 7. Please help us with our grant requests by answering this question.

What ethnicities would best describe your child(ren)? Check all that apply.

African American/Black

Asian

Caucasian

Hispanic/Latinx

Indigenous American

Pacific Islander

Prefer Not to Answer

Other (please specify)

Nourish 282 Food Assistance Program

Enrollment Form

Question Title

* 1. Parent/Guardian Name

Question Title

* 2. Children in HouseholdChildren 0-1 year, please list 'grade' as infantChildren 1-5 years, please list 'grade' as pre-k

Question Title

* 3. Once students return to school, gift cards can be picked up through your child's school. Please choose which school you prefer to pick up your gift cards.

Question Title

* 4. Would you prefer your gift cards be from Aldi or Cub?

Question Title

* 5. How many people reside in your household? (adults and children)

Question Title

* 6. Which of the following languages would you prefer to receive written communication in? (Please select all that apply.)

Question Title

* 7. Please help us with our grant requests by answering this question. What ethnicities would best describe your child(ren)? Check all that apply.

Nourish 282
Food Assistance Program

* 2. Children in Household
Children 0-1 year, please list 'grade' as infant
Children 1-5 years, please list 'grade' as pre-k

* 7. Please help us with our grant requests by answering this question.

What ethnicities would best describe your child(ren)? Check all that apply.