2015 Summer Meal Program Questionnaire

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* 1. School Site (location of summer program)

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* 2. Site Coordinator contact information

Name

Email

Phone number

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* 3. Summer Program information

Number of students enrolled in program

Program Dates (ex.6/1/2015-7/17/2015)

Program start time (9:00am)

Program end time (5:00pm)

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* 4. If multiple programs are at this site, please list.

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* 5. Are you interested in the SFUSD Seamless Summer Meal Program?

Yes

No