Georgia School Nutrition Program

Georgia School Nutrition Program

Application to Participate in the

United States Department of Agriculture (USDA)

Fresh Fruit and Vegetable Program (FFVP)

For School Year (SY) 2015 - 2016

Please do not rearrange the formatting on this page

SECTION A:

SCHOOL INFORMATION

1. School System ID (3 digits for public or 7 digits for non-traditional systems):

2. School System Name:

3. School ID (4 digits; the first digit might be zero):

4. School Name:

SCHOOL DATA

5. School Enrollment as of the first Full Time Equivalent (FTE) count October 20141:

6. Grade Levels (check all that apply):

Pre-K

1st

2nd

3rd

4th

5th

Other

If other, please explain:

7. Meals offered (check all that apply):

School Breakfast Program (SBP)

National School Lunch Program (NSLP)

Afterschool Snack Program (ASP)

8. Food preparation method (on-site, satellite, vended):

If other, please explain:

9. Does the school contract with a food service management company? Yes No

If this school is a Community Eligibility Provision (CEP) school skip to # 11 below.

10. Free and reduced price meal data as of the first FTE count completed in October 2014

% of students that qualified for Free Meals

% of students that qualified for Reduced Price Meals

11. If this school is a Community Eligibility Provision (CEP) school:

_____% Enter the claiming percentage for free meals at this school only.2

1If the enrollment as of the first FTE count completed in October 2014 did not accurately reflect the number of students in your school that were able to participate in the NSLP, please attach a separate sheet fully explaining why there is a difference. For example, if this school serves special needs students from surrounding schools that attend this school all day, every day, then you likely had a greater number of students on campus than is reflected in the FTE count. Likewise, if this school has students in the FTE count that are served by another school then you likely had a lesser number of students on campus than is reflected in the FTE count.

2 CEP ONLY:

þ Determine the total categorically eligible students for free meals at this school as of April when the application for CEP was submitted.

þ Divide this number by the enrollment at the time of the application.

þ Multiply this number by 1.6 as determined by USDA.

þ Multiply this number by 100 and enter this in # 11 above.

è If this number is greater than 100 then enter 100.

CEP schools are required to submit your application along with your CEP Participation Worksheet (District/Sponsor Sites OR Group Sites OR Individual School Sites) that shows enrollment as of April 1st as well as the total of all students categorically approved for free meals at the time of your CEP application.

Please check the appropriate circle below:

⃝ This school did not have the FFVP in SY 2014-2015 – continue with SECTIONS B and C

⃝ This school had the FFVP in SY 2014-2015 – skip to SECTION C

SECTION B:

FFVP APPLICATION

1. School Needs and Benefits for USDA FFVP

A. Identify 2-3 reasons why your school should be chosen to participate in the USDA FFVP.

B. What community/school/student needs are present?

C. Describe how students in your school will benefit from this program.

2. Effective and Efficient Use of Existing Personnel and School Cafeteria Resources to Support the USDA FFVP

A. Identify your school’s use of existing School Nutrition resources such as labor, experience, storage, equipment, and others to effectively participate in the FFVP.

B. Describe the support and commitment of each of the following relative to the FFVP:

· School Nutrition Staff:

· School Administration:

· Faculty/Teachers:

3. Partnerships (Internal and External)*

Briefly describe any past community partnerships that will also be in place for SY 2015-2016 that will support or enhance this program if your school is selected to participate.

*Schools should establish partnerships with organizations funded from non-federal resources to provide additional resources to implement the program. However, partnerships with agencies such as the local health department, Cooperative Extension, etc. are also encouraged for contributing to the educational aspect.

4. Promotion/Marketing of Fresh Fruits and Vegetables to Students and Informing Parents and the Community of the Program

a) Describe your plan for effective marketing/promoting of the USDA FFVP and of fresh fruits and vegetables within the school (with students, teachers, administration, etc.).

b) Detail how families of the students and the community will be notified of the program initially and how the program and fresh fruits and vegetables will be promoted/marketed on an on-going basis.

5. Nutrition Education Activities

a) Describe the nutrition education activities that are planned in the classroom to coordinate with fresh fruits and vegetables served to students participating in the USDA FFVP. Emphasis on more locally-grown or sourced fresh fruits and vegetables is encouraged.

b) Identify any past Nutrition Education successes that will support or enhance the implementation of the FFVP if selected to participate in the program.

This is the completion of the five (5) questions to be answered for the School Application. The five (5) questions must be completed to meet the requirements for a FFVP.

To complete the School Application, remember to complete the Signature Page which follows this instruction. All four (4) signatures with dates are required to complete the School Application. An incomplete Signature Page will result in disqualifying the applying school’s FFVP School Application. Also, the signature/date of each individual confirms that he/she read, understood, and approved the entire School Application. If there are any questions or concerns regarding this instruction, please contact Ms. Danna Ogletree at (404) 971-0408.

The application packet must be received via email or postmarked no later than midnight March 2, 2015. Save time, money and ensure that your application arrives by the due date by emailing your complete application and signature page to . Or, mail via US Postal Service, UPS, Fed Ex, or other courier to Danna Ogletree, School Nutrition Program, 205 Jesse Hill Jr. Drive SE, 1570 Twin Towers East, Atlanta, GA 30334.

Note: A state can choose not to select a high-needs school if the:

· School fails to meet the deadline for application completion and/or submission;

· School does not have the support of its administration;

· State has concerns with the school’s administration of another child nutrition program; or

· State believes that a school cannot properly operate the FFVP despite previous support from the State.

Georgia Department of Education

Richard Woods, State School Superintendent

February 2, 2015 • Page 2 of 4

“This institution is an equal opportunity provider.”

SECTION C:

SIGNATURES (All four are required.)

Your signature below indicates you have reviewed the SY 2015-2016 application and attest to the information provided. If selected, you agree to implement the program as outlined in your application and in a manner consistent with the policies and procedures established by USDA. Further, you agree to participate in any USDA-sponsored evaluations and to provide the information requested by the specified deadlines. Please provide the contacts shown below or equivalent positions as determined by the school.

School Nutrition Manager
Name(Print) / Signature / Date
School Principal
Name(Print) / Signature / Date
School Nutrition Director
Name(Print) / Signature / Date
District Superintendent
Name(Print) / Signature / Date

“USDA is an equal opportunity provider and employer.”

U:\FDU\FFVP Applications\2015\FFVP Application for SY 2015-2016

Georgia Department of Education

Richard Woods, State School Superintendent

February 2, 2015 • Page 2 of 4

“This institution is an equal opportunity provider.”