Come and EAT IT School Sign Up Form

1
School Name* This field is required.
2
School District* This field is required.
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
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Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
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Ukraine
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United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Campus Phone Number* This field is required.
Please enter a valid phone number.
5
Website* This field is required.
6
What grade will be participating?* This field is required.
Please Select
Please Select
4th
5th
7
What is the total number of students in the participating grade?* This field is required.
8
Who is the District's/Campus Food Service Provider?* This field is required.
Please Select
Please Select
Aramark
Self-Operations
Other
9
If you chose "Other" - please note below
10
Principal Name* This field is required.
First Name
Last Name
11
Principal Email* This field is required.
example@example.com
12
Phone Number* This field is required.
Please enter a valid phone number.
13
Email* This field is required.
example@example.com
14
School Primary Contact - Day of Event Contact (IF OTHER THAN THE PRINCIPAL)* This field is required.
First Name
Last Name
15
Phone Number* This field is required.
Please enter a valid phone number.
16
Email* This field is required.
example@example.com
17
PTA/PTO Contact* This field is required.
First Name
Last Name
18
Email* This field is required.
example@example.com
19
Is this a Title 1 School?* This field is required.
YESNO
20
What is the percentage (%) of students receive Free/Reduced Lunch?* This field is required.
21
Student Population Demographic Information * This field is required.Total must equal 100%
Total Demographic Percentage
Free and Reduced Lunch Percentage
Hispanic or Latino
Row 0, Column 0
Row 0, Column 1
NH Black or African American
Row 1, Column 0
Row 1, Column 1
NH White
Row 2, Column 0
Row 2, Column 1
NH Asian
Row 3, Column 0
Row 3, Column 1
Other
Row 4, Column 0
Row 4, Column 1
Hispanic or Latino
NH Black or African American
NH White
NH Asian
Other
Total Demographic Percentage
Row 0, Column 0
Free and Reduced Lunch Percentage
Row 0, Column 1
Total Demographic Percentage
Row 1, Column 0
Free and Reduced Lunch Percentage
Row 1, Column 1
Total Demographic Percentage
Row 2, Column 0
Free and Reduced Lunch Percentage
Row 2, Column 1
Total Demographic Percentage
Row 3, Column 0
Free and Reduced Lunch Percentage
Row 3, Column 1
Total Demographic Percentage
Row 4, Column 0
Free and Reduced Lunch Percentage
Row 4, Column 1
1 of 5
22
Do you currently have any of the following?* This field is required.Choose all that apply
Outdoor Edible Space (growing fruits and vegetables)
Outdoor Gardening Space (no fruits/vegetables)
Hydroponic Program
Cooking Program
23
Are the programs previously chosen available to ALL students?* This field is required.
YESNO
24
If it's not available to ALL Students, please briefly tell us why:
Huge
Large
Normal
Small
Ok
Ok
25
Microgrant Acknowledgement for Come and EAT IT Participation* This field is required.By opting into the Come and EAT IT program, we acknowledge receipt of a microgrant from Independence Gardens to support fresh food access initiatives. These funds must be used for programs specifically designated to promote healthy eating and nutrition education, such as: - Outdoor edible spaces (gardens, HydroTowers, etc.) - Cooking programs or culinary classes - Fresh food tastings or student-led food initiatives - Nutrition education activities focused on fruits, vegetables, and whole foods As part of this agreement, we commit to: 1. Using the microgrant exclusively for the purposes outlined above, in alignment with Independence Gardens' mission to provide every child access to fresh, nutritious food. 2. Completing an annual survey to report how and where the funds were used to enhance fresh food access on campus.
Yes, we acknowledge the above statement
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