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What region / area is your school located? *

Logan Ipswich Brisbane (South) Brisbane (North) & Moreton Bay Brisbane (South/West) My School is outside of these areas but is willing to collect supplies from Logan

Name of School *

Suburb where your School is located *

Does this request have support of the Principal *

How many mornings a week would your school like to run a breakfast program? *

N.B. Schools who can only run a breakfast program once or twice a week (i.e. less than 3 days) may not be eligible for direct deliveries or loan of large equipment)

If your school can only run its breakfast program one or two mornings a week, will your school be able to collect food supplies from Logan or a neighbouring school (if avail as an option)? *

NA -we can run our program 3 or more days a week We can collect supplies from Logan We can collect from another school if avail as an option No, we are unable to collect from anywhere Other

How should we contact you?

Phone Email

Estimated number of students who will attend your breakfast program per day? *

How long will the breakfast program run for each morning: *

15 minutes max 20 minutes max 25 minutes max 30 minutes max 30+ minutes Other

Where will your school run the breakfast program: *

From within or outside of the Tuck Shop From within or outside of a Hall Kitchen From within or outside of the Staff Lunch Room From within or outside the Special Education Unit Outside of a Classroom and undercover Other

What access and visibility will the breakfast program have (select all that apply): *

A busy well known area where lots of students go A quite area where not many students go A closed off area where students will need to seek permission to enter A small area where student numbers will need to be limited Other

Who will the breakfast program be open to: *

Any student within the whole school who wishes to participate Prep students only Prep and Junior students only (in a P-12 school) Special Education students only Only students teachers identify as hungry Other

Please provide information that demonstrates the School's need for a Breakfast Program *

Do you have a team of volunteers or teachers to assist you with running the breakfast program? *

Yes, I have a team ready to help Not yet, but I am close to having a full team No, I need help advertising for volunteers No, but I can run it on my own Other

Comments

Your Full Name *

Your position or role *

Your Email

Your Email: *

example@example.com

Your Phone Number *

How did you hear about the YMCA Schools' Breakfast Program? *

Google search Word of mouth I (or someone in my school) used to work in a school with a Breakfast Program supported by the YMCA Through Scripture Union Other