/ STUDENT NUTRITION PROGRAM (SNP)
GRANT APPLICATION
Funding Period
(April 1st to March 31st)
Ø  All sections of this form must be completed for Algoma Family Services to consider your application. Deadline Date: January 31st
Ø  Previously funded programs must submit all reports before repeat funding can be granted.

SCHOOL INFORMATION

School:
School Board:
Address (street address, city and postal code) :
Phone:
Fax:
Principal:
Principal email:
Secretary:
School Lead Contact/Coordinator:
Lead Phone:
Lead Email:
School Financial Contact:
Financial email:
District: / SSM Central/East Algoma
North Algoma Hornepayne
Language /Correspondence Preference: / English French
Type of school: / Elementary Secondary Alternative
First Nation: / Yes No
School Enrolment:

Demographics:

Has your demographic information changed? Yes No

If yes, please tell us about the population of your school and the surrounding community: i.e. proportion of newcomers, large ethnic populations, socioeconomic status including new/lost jobs, remote/urban community challenges, etc.

Group Funding: AFS Student Nutrition Program continues to research grant opportunities to support school-based nutrition programs. If an opportunity arises, would you like to be included in the group application? No Yes If yes, staff will consult with you as we prepare the application.

PROGRAM OFFERED

Meal Program (i. e. breakfast, morning meal, or lunch) contains a least one serving from a minimum of three out of the four food groups of Canada’s Food Guide with at least one serving from Vegetables and Fruit food group and at least one serving from the Milk and Alternatives food group. / Snack Program contains at least one serving from a minimum of two food groups of Canada’s Food Guide with at least one serving from the Vegetables and Fruit food group.

Please select the type of program that best meets the nutritional needs of your school.

Breakfast (offered prior to the start of the school day) / AM Snack
Morning Meal (offered in the first part of the school day) / PM Snack
Lunch

BUDGET - Please Estimate (April 1st to March 31st)

A. What is the anticipated start date of your program? (Use April 1st unless you are a new program and you anticipate a late start date.)
B. What is the anticipated end date of your program? (Use March 31st unless your program anticipates an early end date.)
C. How many weeks will you offer the program? (Calculate the number of weeks your program will run - maximum 38 weeks.)
D. How many days per week will you offer the program? (2, 3, 4, or 5)
E. Estimate the number of students that will access your program daily.
F. Average Cost per Meal
Breakfast/morning meal =$2.00/day
AM/PM Snack=$1.25, Lunch=$3.00/day
G. TOTAL FOOD COSTS: (C x D x E x F)

Volunteers: Are you in need of volunteers? No Yes How many?

Safe Food Handling: Do you have at least one person on-site certified in the last five years in Food Safety? Yes No

Is there a need for volunteers to be trained in Safe Food Handling? No Yes How many?

Equipment: Does your school require equipment for the upcoming fiscal year?

No Yes If yes, please complete APPENDIX I.


ESTIMATE PROGRAM EXPENSES

(April 1st to March 31st)

Food (Bring forward Total Food Costs “G” found on page 2 of this application) / $
Equipment (Bring forward Total Equipment Costs “H” found on page 6 of this application) / $
Supplies (Estimate miscellaneous costs for forks, hairnets, dish soap, baggies, etc.) / $
Other (Please list) / $
TOTAL EXPENSES / $

Declaration:

I, ______the authority for this organization, confirm that the information in this application is true and correct and agree to:

Use funds exclusively for the purposes outlined in my application. Spend all funds within the appropriate funding period. Any unspent funds may be deducted from next year’s grant and if my program ceases to operate, unspent funds will be returned to: Algoma Family Services Student Nutrition Program.

Should our program change format or cease to operate, I will contact the AFS Student Nutrition Program at

705-945-5050/1-800-461-2237. Any equipment purchased with/by MCYS or other funders, working in partnership with AFS Student Nutrition Program, will be reallocated to AFS for redistribution to other SNP programs in need.

Offer a program that is non-stigmatizing and open to all students regardless of their ability to pay.

Read the SNP Eligibility Requirements and do everything possible to meet it. http://www.algomafamilyservices.org/index.php?g=3,24,63

Serve nutritious food that meets the Ministry of Children and Youth Services SNP Nutrition Guidelines, July 2008. Efforts will be made to serve foods that are inclusive and sensitive to the faiths and cultures of our students.

http://www.children.gov.on.ca/htdocs/English/topics/schoolsnacks/nutrition_guidelines.aspx

Maintain Food Safety Standards in accordance with the Health Protection and Promotion Act for Food Premises, R.R.O. 1990, and REGULATION 562.

http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900562_e.htm

Have at least one person on-site certified in the last five years in Food Safety. Staff and volunteers will be encouraged to attend Food Handler Training as opportunities arise.

Submit activity and financial reports every month, and provide additional information as requested by Algoma Family Services Student Nutrition Program.

Allow the program to be visited by one or all of the following: funders, public health dietitian and/or inspector, school board representative and other community stakeholders.

Let SNP share program information, on an as needed basis, with representatives of school boards, SNP Advisory Coalition, funders, public health and other community stakeholders,

Signature Title Date

4

School Name:

Program Offered: _ ____

SAMPLE MENU YOUR MENU

Food Group / Breakfast Sample / Snack Sample / Lunch Sample / Monday / Tuesday / Wednesday / Thursday / Friday
Vegetables and fruit / ½ cup (125ml) 100% unsweetened juice / 1 small apple / ½ cup cucumber and bell pepper strips
Grain Products / 1 slice whole wheat bread / 1 whole wheat tortilla
Milk and Alternatives / 50g (1 ½ oz.) mozzarella cubes / ¾ cup (175g) low fat yogurt / 1 cup (250ml) milk
Meat and Alternatives / 1 boiled egg / 75g (2 ½ oz.) light tuna
Other foods / 1 tbsp. (15ml) light mayonnaise

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APPENDIX I

EQUIPMENT REQUESTS

One-time equipment grants, when available, will be granted to support start-up and maintenancecosts for your breakfast, morning meal, lunch and/or snack program.

Equipment requests will be awarded as follows:

1) Pending funding availability;

2) As it relates to the service delivery of your SNP program giving priority to items that address safe food handling practices.

Please list below your equipment needs and estimated costs:

Item / Quantity / Description / Total Equipment Costs
(excluding HST) /
i.e. Fridge / 1 / GE All Fridge 2316 / 850.00
i.e. Stock Pot / 2 / 1-10qt $60, 1-16qt $90 / 150.00
Fridge
Freezer-chest
Freezer-upright
Stove
Dishwasher
Cupboards
Counter
Sink(s)(double, triple, hand)
Toaster-rotisserie
Toaster-four slice
Grill/griddle
Microwave
Blender
Kettle
Pots and Pans:
Stock Pot(10,12,16,20qt)
Braizer (Dutch oven-8,15,20qt)
Sauce Pan (2,4…10qt)
Baking Tins
Utility Cart
Storage Bins/ containers/platters
Cutting Boards
Plates
Cups
Bowls
Silverware
Knives (utility, paring…)
Milk /juice containers
Peelers/cutters (vegetable, cheese, fruit)
Can Opener
Serving Tongs
Mixing Bowls
Mixing spoons, spatulas, lifters
Oven mitts
TOTAL EQUIPMENT COSTS / H.

4