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* 1. Name:

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* 2. Title:

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* 3. Organization/Site name:

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* 4. Email:

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* 5. Phone:

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* 6. Please provide a name and contact information for the staff person who would facilitate the Meal Plan Challenge. They will need to attend a 2-hour training prior. If you do not know yet, please indicate when you will know.

Program Information

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* 7. How many weeks will your Summer program run?

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* 8. What is the projected start date for your Summer program?

Date

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* 9. Do you have access to computers or tablets at your site?

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* 10. What will the ratio be of students to computers/tablets (ideally no more than 3 students/computer
to be eligible for this program)?

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* 11. Do you have a kitchen at your site that would be open for use during the final cooking event?

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* 12. If you do not have a kitchen at your site, do you have access to a sink and an outlet?

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* 13. Which grades would you want to include in the EatFresh.org Meal Plan Challenge? Check all that apply.

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* 14. How many students do you anticipate will be in the Meal Plan Challenge group? We ask that the same group of students participate in all three sessions.

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* 15. Do you have a sense of when you would run the curriculum (basic dates) so we can best coordinate staff support for the final cooking activity.

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* 16. Why are you interested in participating in the EatFresh.org Meal Plan Challenge?

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* 17. What other nutrition programs have you tried in your summer program? What are your reflections on these efforts? Do you plan to implement other nutrition programs or activities this summer?

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* 18. What outcomes do you hope to get from your nutrition programming this summer?

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* 19. What else would you like to tell us about your program or your community?

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