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Instructions for

food & nutrition Division

SUMMER FOOD SERVICE PROGRAM

SITE APPLICATION

SECTION I – Site Location and contact information

  1. Name of Contracting Entity - Enter the name of the Contracting Entity that is sponsoring the site that this Site Application is being completed for.
  2. Name of SFSP Site – Enter the name of the SFSP site for this application.
  3. County – Enter the name of the county in which the site resides in.
  4. Street Address of Site – Enter the street address, city, state and zip of the site.
  5. Nearest Cross Street(s) – Enter the nearest cross street(s) closest to the site.
  6. Mailing Address of Site – Same as Street Address – Indicate “Yes” or “No”.
  7. Mailing Address of Site – If the mailing address is not the same as the street address, enter the mailing address, city, state and zip of the site.
  8. Contracting Entity Contact for this Site – Enter the following for the contracting entity’s contact for this site: name, email address, phone number, fax number and title.
  9. Site Supervisor – If the site supervisor of this site is different than the Contracting Entity Contact for this site, enter the following for the Site Supervisor for this site: name, email address, phone number, fax number and title.

SECTION II – general site information

  1. Geographic Location – Indicate if the site is Rural or Urban.
  2. Has this site ever participated in the SFSP under this Contracting Entity? – Indicate Yes or No.

SECTION III – site eligibility

  1. Is this site a licensed child care facility? – Indicate Yes or No.

a.  If this site is a licensed child care facility, will this site only serve children who are enrolled for care? Indicate Yes or No.

b.  If this site will serve children who are enrolled for care, will all children be served together in a common area that is not licensed for child care? - Indicate Yes or No.

  1. Is this site open to only enrolled summer school students who receive academic credit? - Indicate Yes or No.
  2. Did this site operate last year? - Indicate Yes or No. If No, enter the date that you conducted the site’s pre-operational site visit.
  3. Has this site experienced significant operational problems last program year? - Indicate Yes or No. If Yes, enter the date that you conducted the site’s pre-operational site visit.
  4. Has this site experienced significant SFSP staff turnover since last program year? - Indicate Yes or No. If Yes, enter the date that you conducted the site’s pre-operational site visit.
  5. If this is a new site, enter the date of the Contracting Entity’s pre-operational site visit, if applicable. – Enter the date that you conducted the site’s pre-operational site visit.
  6. Do you know of another SFSP or Seamless Summer Option feeding site within one-fourth mile? – Indicate Yes or No.

a.  If Yes, list the name of the Contracting Entity and the name of the site within one-fourth mile.

b.  The site within one-fourth milk is under my Contracting Entity. Indicate Yes or No.

  1. Explain how the two or more sites will not serve the same group of children for the same type of meal service. Self-explanatory.

SECTION IV – SITE TYPE

1.  Indicate the Site Type for this Site. - Indicate whether the site type from the drop-down list.

2.  Indicate the Eligibility Method for the Site Type. – For the type of site indicated above, select the eligibility method used from the drop-down list.

3.  Indicate the Primary Service Provided by this Site. – For the type of site indicated above, select the primary service provided by the site from the drop-down list. If you select “Other”, please describe.

4.  If School Data is selected, provide the complete name of the school district, school name and the percentage of free and reduced-price eligible students from which this site will draw its attendance.

a.  School District – Provide the name of the school district from which the site draws its attendance.

b.  School Name – Provide the name of the school from which the site’s eligibility is being established.

c.  Percentage of Enrollment Eligible for Free and Reduced-Price Meals – Enter the percentage of enrollment that is eligible for free and reduced-price meals from the school listed in (b).

5.  If this site is a public school site and another school’s data was used to establish eligibility for this site, explain why another school’s data was used. – Self-explanatory.

6.  If Census Data is the selected eligibility method, enter the following:

a.  Block Number – Enter the block number for site.

b.  Group Number – Enter the group number for the site.

c.  Percentage of Needy Children – If you know the percentage of eligible children, please enter.

7.  If Restricted Open or Closed-Enrolled is selected as site type, provide reason for operating this type of site. – Self-explanatory.

8.  If Site Type is Closed-Enrolled, provide the following information:

a.  Projected Number of Enrolled Children – Indicate the estimated number of children who will be enrolled at the site.

b.  Projected Number of Enrolled Children who are eligible to receive free or reduced-price meals – Indicate the estimated number of enrolled children who are eligible to received free or reduced-price meals.

c.  Percentage of Enrolled Children – Calculate the percentage of enrolled children who are eligible for free or reduced-price meals.

9.  If Site Type is a Camp, will there be a separate charge for meals served to non-eligible children? - Indicate Yes or No. If Yes, submit the “Method for Collecting Payment and Additional Assurances” form with your application.

SECTION V – SITE OPERATION

1.  a. On the calendars below, check the box(es) of the day(s) that you will be operating. – Check each box to indicate the day(s) you will be operating the SFSP.

b. If you operate in months outside of the months listed above, indicate the month and dates of operation. – If you operate in a month that a calendar is not listed for (i.e., September), indicate the month and dates of operation for that month.

2.  Check the meal type(s) to be served at this site. – Check the box of each meal type(s) that will be served at this site.

3.  If this is not a Camp site or a site whose primary service is migrant and if this site is serving Supper instead of Lunch, please explain why. – Self-explanatory.

4.  Indicate your system for serving meals to attending children. – Check the appropriate box that describes your system for serving meals to children.

5.  Indicate if this site is an outdoor or mobile site. Indicate Yes or No.

6.  Indicate if this site allows a fruit or vegetable component to be consumed off site. Indicate Yes or No.

7.  Indicate how the site supervisor will communicate the number of meals that will be needed for the following day. – Check the appropriate box.

8.  Are you requesting a waiver for the First Week Site Visit? Indicate Yes or No. If you are checking “Yes”, you are indicating that this site is staffed by experienced SFSP personnel, operated in the prior year, and have had no significant SFSP operational problems in the prior year.

SECTION VI – BREAKFAST

1.  Meal Service Method. – Check the appropriate box for the meal service method for this site.

2.  Menu Planning Option. – Select the menu planning option to be used at this site from the drop-down list.

3.  Months and Operating Days of Meal Service. – Self-Explanatory.

4.  Meal Serving Dates (Non-Camp sites only). – Indicate the start date and end dates of the breakfast meal service.

5.  Meal Times. – Indicate the start time and end time of the breakfast meal service.

6.  Average Daily Participation (Non-Camp only). – Indicate your average daily participation.

7.  Indicate your plan for the receipt and storage of meals before serving to children. –Check the appropriate box of how you will ensure safe receipt and storage of meals.

8.  Indicate your plan for the storage or disposal of leftover meals or components. – Select the plan for storage or disposal from the drop-down list.

9.  Indicate your plan for serving meals during inclement weather. – Select the plan for meal service during inclement weather from the drop-down list. If you select “Other”, please provide an explanation in the space provided.

SECTION VII – A.M. SNACK

1.  Meal Service Method. – Check the appropriate box for the meal service method for this site.

2.  Menu Planning Option. – Select the menu planning option to be used at this site from the drop-down list.

3.  Months and Operating Days of Meal Service. – Self-Explanatory.

4.  Meal Serving Dates (Non-Camp sites only). – Indicate the start date and end dates of the a.m. snack meal service.

5.  Meal Times. – Indicate the start time and end time of the a.m. snack meal service.

6.  Average Daily Participation (Non-Camp only). – Indicate your average daily participation.

7.  Indicate your plan for the receipt and storage of meals before serving to children. –Check the appropriate box of how you will ensure safe receipt and storage of meals.

8.  Indicate your plan for the storage or disposal of leftover meals or components. – Select the plan for storage or disposal from the drop-down list.

9.  Indicate your plan for serving meals during inclement weather. – Select the plan for meal service during inclement weather from the drop-down list. If you select “Other”, please provide an explanation in the space provided.

SECTION VIII - LUNCH

1.  Meal Service Method. – Check the appropriate box for the meal service method for this site.

2.  Menu Planning Option. – Select the menu planning option to be used at this site from the drop-down list.

3.  Months and Operating Days of Meal Service. – Self-Explanatory.

4.  Meal Serving Dates (Non-Camp sites only). – Indicate the start date and end dates of the lunch meal service.

5.  Meal Times. – Indicate the start time and end time of the lunch meal service.

6.  Average Daily Participation (Non-Camp only). – Indicate your average daily participation.

7.  Indicate your plan for the receipt and storage of meals before serving to children. –Check the appropriate box of how you will ensure safe receipt and storage of meals.

8.  Indicate your plan for the storage or disposal of leftover meals or components. – Select the plan for storage or disposal from the drop-down list.

9.  Indicate your plan for serving meals during inclement weather. – Select the plan for meal service during inclement weather from the drop-down list. If you select “Other”, please provide an explanation in the space provided.

SECTION IX – P.M. SNACK

1.  Meal Service Method. – Check the appropriate box for the meal service method for this site.

2.  Menu Planning Option. – Select the menu planning option to be used at this site from the drop-down list.

3.  Months and Operating Days of Meal Service. – Self-Explanatory.

4.  Meal Serving Dates (Non-Camp sites only). – Indicate the start date and end dates of the p.m. snack meal service.

5.  Meal Times. – Indicate the start time and end time of the p.m. snack meal service.

6.  Average Daily Participation (Non-Camp only). – Indicate your average daily participation.

7.  Indicate your plan for the receipt and storage of meals before serving to children. –Check the appropriate box of how you will ensure safe receipt and storage of meals.

8.  Indicate your plan for the storage or disposal of leftover meals or components. – Select the plan for storage or disposal from the drop-down list.

9.  Indicate your plan for serving meals during inclement weather. – Select the plan for meal service during inclement weather from the drop-down list. If you select “Other”, please provide an explanation in the space provided.

SECTION X - SUPPER

1.  Meal Service Method. – Check the appropriate box for the meal service method for this site.

2.  Menu Planning Option. – Select the menu planning option to be used at this site from the drop-down list.

3.  Months and Operating Days of Meal Service. – Self-Explanatory.

4.  Meal Serving Dates (Non-Camp sites only). – Indicate the start date and end dates of the supper meal service.

5.  Meal Times. – Indicate the start time and end time of the supper meal service.

6.  Average Daily Participation (Non-Camp only). – Indicate your average daily participation.

7.  Indicate your plan for the receipt and storage of meals before serving to children. –Check the appropriate box of how you will ensure safe receipt and storage of meals.

8.  Indicate your plan for the storage or disposal of leftover meals or components. – Select the plan for storage or disposal from the drop-down list.

9.  Indicate your plan for serving meals during inclement weather. – Select the plan for meal service during inclement weather from the drop-down list. If you select “Other”, please provide an explanation in the space provided.