Feeding South Florida's Afterschool Meals Interest Form

Feeding South Florida's Afterschool Meals Interest Form

Please complete this form if you are a community agency in Palm Beach, Broward, or Miami-Dade counties interested in becoming an Afterschool Meals site with Feeding South Florida.

Agencies must have enough individuals available before, during and after meal times who will regularly provide meal counts/reporting information to Feeding South Florida.

QUESTIONS?
Please contact:

Adriana Moncada at amoncada@feedingsouthflorida.org or 954.518.18.18 x 1827 or,

Xavier Parker at xparker@feedingsouthflorida.org or 954.518.1818 x 1815.
ABOUT YOUR ORGANIZATION

Tell us a little bit about you and the organization running your afterschool program
Contact Person Name*

First NameLast Name
Contact Person Email*
example@example.com
Agency/Organization Name*
Agency/Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Are you a for-profit organization?*

YesNo
Do you currently operate the Child Care Food Program?*

YesNoUnsure
If Yes in the previous question, who is your current provider/sponsor?
Do you maintain afterschool services at more than one site?

YesNo
If Yes in the previous question, please complete and submit one separate application per location (site)
ABOUT YOUR SITE

Share some information about your site and the participants
Type of Site*
How many children are currently enrolled in your program? *
What ages of children will you serve (Age 0-18)?*
Days of the week you are available to serve (select all that apply)*

MondayTuesdayWednesdayThursdayFriday
What day can you begin service? (As early as ....)*
What type of meal is your site interested in providing?*

PM SnackDinnerPM Snack + Dinner
Approximately how many meals do you anticipate serving per day? *
Do you have access to refrigeration, if needed?*
If Yes, how many refrigerators do you have available?
Do you have ovens to reheat meals, if necessary?*

YesNo
If Yes, how many ovens do you have available?
If Yes, how many staff know how to use the ovens?
Do you have a loading dock or efficient access to move Cambros (food warmers/coolers) into the facility, if necessary?*

YesNo
Do you have reliable and convenient electricity to plug in the Cambros as necessary?*

YesNo
Have your volunteers/staff passed background checks?*

YesNo
What marketing outlets does your site have access to? (e.g. email, Instagram, etc.)*
ABOUT YOUR STAFF

Let us know a little bit about who will run the afterschool meal program at your site
Who is the Site Supervisor?*

First NameLast Name
Position/Title of Site Supervisor*
Email Address for Site Supervisor*
Phone Number for Site Supervisor*

Area CodePhone Number
Who is the alternate Site Supervisor?*

First NameLast Name
Position/Title of the alternate Site Supervisor*
Email address for alternate Site Supervisor*
Phone number for alternate Site Supervisor*

Area CodePhone Number
ABOUT YOUR PROGRAM

Share a little information about your program content & oversight
Does your Site offer an educational/enrichment component as part of your program?

YesNo
Documentation of Licensing Status: Does your site currently possess one of the following that includes the site’s name and current address? 1. A Child Care License issued by the Department of Children & Families (DCF) or a local licensing agency, OR; 2. A Letter from DCF or Local Licensing Agency stating that licensure is not required, OR; 3. A Religious-Exempt Accreditation Certificate

YesNo
Food Service Documentation: Does your Site possess a Food Sanitation Permit from the Florida Department of Health (FDOH) allowing for the operation of food service?

YesNo
Documentation on Maximum Capacity: Does your Site maintain documentation identifying the maximum allowed occupancy of your space (usually obtained by a Fire Marshall or Certificate of Occupancy)?

YesNo
Please note this is an interest form and submitting this information is not a guarantee or confirmation that FSF will provide Afterschool Meals to your Organization.

Thank you for helping us change lives one meal at a time. Together, we're Feeding South Florida!
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. To file a complaint of discrimination, write Office of the Assistant Secretary for Civil Rights, U.S. Department of Agriculture, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call 866-632-9992 or 202-720-2600 (voice and TTY). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. USDA is an equal opportunity provider and employer.
This is a fill in the blanks field. Please add appropriate blank fields and text.
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ABOUT YOUR ORGANIZATION

ABOUT YOUR SITE

ABOUT YOUR STAFF

ABOUT YOUR PROGRAM