Name Of Site
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County
*
Please Select
Jackson
George
Greene
Hancock
Harrison
Pearl River
Perry
Stone
Site Supervisor Information
Site Supervisor Name
*
First Name
Last Name
Site Supervisor Birthdate
*
-
Month
-
Day
Year
Date
Site Supervisor Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Site Supervisor Work Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Site Supervisor Email
*
example@example.com
Alternate Site Supervisor Name
*
First Name
Last Name
Alternate Site Supervisor Birthdate
*
-
Month
-
Day
Year
Date
Alternate Site Supervisor Work Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Site Supervisor Email
*
example@example.com
Program Information
Start Date of Program
*
-
Month
-
Day
Year
available on the first day of school
End Date of Program
*
-
Month
-
Day
Year
available until the last day of school
Holiday Closings
*
Expected Average Daily Attendance
*
number of kids per day
What is the age range of children being served?
*
ex. 8-12years
What is the name of the nearest school?
*
Meal Service Information
What days will your site serve meals?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Meal Service Selection-maximum of 2
*
Supper
Snack
Holiday Breakfast
Snack Serving Time
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Supper Serving Time
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Holiday Breakfast Serving Time
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Documentation Requirement
In order for your application to be accepted, please submit ALL required documents.
Fire Marshall Inspection
*
Browse Files
Drag and drop files here
Choose a file
Required for all sites
Cancel
of
After School Site Agreement
*
Browse Files
Drag and drop files here
Choose a file
Linked above
Cancel
of
Child Care Facility License
Browse Files
Drag and drop files here
Choose a file
Daycare Sites ONLY
Cancel
of
Health Department Inspection
*
Browse Files
Drag and drop files here
Choose a file
Hot Meal Sites Only
Cancel
of
Enrichment Activity Schedule
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signed Site Agreement
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Food Permit-samples above on accepted permits/inspections
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
Signing your name below will have the same authorization as your signature. This application is not a guarantee of participation in the Summer Meals Program. Feeding the Gulf Coast reserves the right to terminate any site found to be noncompliant with regulations.
Submit
Should be Empty: