Children's Hunger Alliance

*Name:

Organization (or school):

*Address:

*City:

*State:

*Zip:

*Phone:

Work Phone:

Email:

The Following Questions Will Help Determine Your Agency's Availability for Program Participation:

Is your organization/agency one of the following?

Public or Non-profit Private School Food Authority

Public or Non-profit Private Residential Summer Camp

State, Local, Municipal or County Government Facility

College or University Participating in the National Youth Sports Program

Other Private Nonprofit Organization

Other:

Does your organization provide a year-round public service to the area in which you intend to provide the Summer Food Service Program?

Yes No

Is the population you will serve children 1-18 years of age? (The program may also be available for children with disabilities enrolled in an educational plan through age 21)

Yes No

Will you serve:

children in low-income areas, or specific groups of low-income children?

Does your organization have one of the following ways to provide meals?

Organization owned kitchen with a Department of Health license

A leased kitchen with a Department of Health license

A contract with a private food service management company

A contract with a local school food service

Other:

Would your organization accept financial and administrative responsibility for your program and sites?

Yes No

* Required Field

For more information on participating in the National Summer Food Service Program, please contact Heather Combs at at 937-534-0600, ext. 302 or HCombs@ChildrensHungerAlliance.org.

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National Summer Food Service Program