Summer Meals Application Form

Summer Meals Community Programs Application

Everett Public Schools Food & Nutrition Services
This application is for summer community programs requesting to host their site as a free meals location. Meals will be provided by Everett Public Schools Food & Nutrition program. The USDA Summer Food Service Program (SFSP) is running July 1 through August 15, Monday through Friday. Only sites that meet the OSPI SFSP requirements will be considered. If approved for the free meals, the site will need to be open to all children ages 1-18 during the meal service time. You might also be required to pick up the meals. All fields are required to be completed. Incomplete applications will not be reviewd.
SITE INFORMATION
Site Name*
Contact Person*
Site Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Summer Hours of Operation

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Days of Operation*

MondayTuesdayWednesdayThursdayFriday
Type of program/enrichment activities*
PLEASE COMPLETE THE FOLLOWING
Beginning Date for Meals*

MonthDayYear
Ending Date for Meals*

MonthDayYear
Which meals will be served and what times? You may only select up to two meals per site. Breakfast may not be available for all sites. We will let you know which meals are approved after processing your application. Please give us your best guess at times. We recommend serviing periods of NO MORE than 30 minutes.
Breakfast?*

YesNo
Lunch*

YesNo
Snack*

YesNo
Breakfast Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Lunch Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Snack Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Estimate the average number of children to be served each day. Must be 10 or more. Sites with less than 10 during the program could be closed.
Breakfast Count*
Lunch Count*
Snack Count*
For the estimated number of children, does the site have (Please check below ALL that apply):

Shelter for inclement weatherAdequate storage for picked up foodAdequate refrigerationAccess to a telephone
Will meal service be at the address given above? If not, where will it be served?

YesNo
Site Address:*

Street Address

Street Address Line 2

CityState

Zip Code
What Everett school is nearest to your meal site?*
Will you be taking field trips that require meals (field trips are any meals served off site)?*

YesNo
Field Trip Form(s). If you don't have them now, you can bring to training meeting. A field form will be attached to your Thank You email. *

Cancelof
Will the above contact person also be the site supervisor? The site supervisor is responsible for ensuring that ALL program requirements are being followed.

YesNo
Site Supervisor Full Name and Title *
Site Supervisor Name and title
Site Supervisor Phone Number*
Please enter a valid phone number.
Please submit this form by April 25. Questions about completing this form, call the Food and Nutrition office at 425-385-4380 or email foodservices@everettsd.org. Mandatory Summer Program training is June 4 at 3900 Broadway, Everett WA. Time TBD, we will send you an official invite when details are set.
Should be Empty:

Summer Meals Community Programs Application

SITE INFORMATION

PLEASE COMPLETE THE FOLLOWING