Application for Summer Food Service Program

Summer Food Service Program (SFSP)

Thursday, June 12, 2014 - Thursday, August 21, 2014

By completing and submitting this application, you understand and agree to:

MEAL REQUIREMENTS AND MEAL SERVICE

  • Children 18 years of age or younger or
  • Individuals 19 and over with a state defined mental or physical disability are eligible to receive meals.
  • Comply with civil laws and regulations in accordance with USDA policy which does not permit discrimination because of race, color, age, sex, handicap or national origin.

As a supervisor or staff member of a site, you will

  • Attend your sponsor's training
  • Provide supervision of structured activities
  • Supervisor with trained staff, distribution of meals by following SFSP guidelines
  • Complete and keep daily records of meals received, served and stored
  • Provide appropriate, secure refrigeration and storage areas according to standards prescribed by local health authorities
  • Keep the site clean and sanitary
  • Work closely with SPPS as your sponsor of summer meals

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).

USDA is an equal opportunity provider and employer.
 

Site Name 
Organization Running Program 
Name of Site Contact Person 
Name of Person(s) Responsible for Meal Service 
Telephone Number ( )___-____  
Additional Telephone Number 
Address 
City 
State 
Zip 
Email 
(*where the refrigerator will be - ex. East door off "street" on..., ground floor at end of front hallway)
*Location in building for delivery of meals 
(gym, hallway, room 212, etc.)
Location where meals are served 
Did this site participate in 2013 SPPS SFSP?

Total number of children expected to eat daily 
Maximum number of people allowed in your building at the same time 
Is this site a non-profit organization


Select only one
Is this site a "Closed Enrolled" or "Open" Site