NEW SCHOOL ENQUIRY

N.B. For your online enquiry to submit, you will need to answer every question. Please put NA next to any Q that is not applicable.

What region / area is your school located? *

Logan Ipswich Brisbane (South) Brisbane (Eastern Suburbs) Brisbane (North) & Moreton Bay Brisbane (South/West) Outside of these areas but able to collect supplies from one of these areas. Outside of these areas and too far away to collect supplies. Other

Name of School *

Suburb where your School is located *

Does this request have support of the Principal *

Please answer the following questions about your school's breakfast program (or proposed program):

Are you seeking support for a 'new' or 'existing' breakfast program? *

New Breakfast Program Existing Program Other

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). *At this stage the YMCA is only able to deliver supplies directly to schools located in Logan, Ipswich, Brisbane & Moreton Bay Regions

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

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

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

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

How long does your school intend to run a breakfast program? *

One term only (as a trial) Two or three terms (as a trial) Long term / ongoing Other

How should we contact you?

Phone Email

Does your school currently receive any 'donations of food' for its Breakfast program? If so, please list the type of food below and who donates them (N.B. This will not disqualify you from receiving for support from the Y). *

Does your school receive any Funding $ specifically for its Breakfast Program? If so, please enter below the $ amount received each year (enter NA or 0 if zero). N.B. This will not disqualify you from applying for support from the Y. *

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, 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

The Y Schools' Breakfast Program