School Food Service Equipment Assistance Grant Application
Due date: 5:00 PM, March 18, 2010
Award Date: No later than April 29, 2010
Funds Expended 12 months from Award
School Food Service Equipment Grant Application
Cover Page
Sponsor
Instructions:
Complete one cover page for the Sponsor and one Site Request per school or Central Kitchen for which funding is being requested. Submit to the Oregon Department of Education Child Nutrition Programs, Attn: Heidi Dupuis, 255 Capitol Street NE, Salem OR 97310 or Fax (503) 378-5156.
Application Page ______of ______
Sponsor Name: ______
Contact Person: ______
Email Address: ______
Mailing Address: ______
______
Phone Number: ______
School Food Authority Required Information:
· School Food Service Fund Operating Budget for 2009-10 and current fund balance.
Assurance
I assure that ______(organization name)
is able, if awarded funding, to fully expend the award funds within 12 months of award date.
Signature of Business Official ______Date______
Print or Type Name: ______
School Food Service Equipment Assistance Grant Application
Site Request
Application Page ______of ______
Instructions:
Complete one Site Request per school for which funding is being requested.
School/Site ______
If Equipment Funded% Free and Reduced –
Oct 2009 / Total Lunches Claimed in 2008-09 / Number of Students to benefit / Increase in Lunch
Meals / Increase in Breakfast Meals
Provide a brief equipment description and cost (e.g., walk-in freezer, two-door refrigerator)
Equipment Description: $______
______
q New / q Replacement / q RenovationFocus of Equipment Purchase: (check all that apply)
q Improving quality of meals
q Improving food safety
Provide food safety inspection to document need
q Improving energy efficiency
q Expanding participation
How will the listed equipment meet the area(s) of focus checked above? Use as many additional pages as needed.
Central Kitchen Equipment Grant Application
Application Page ______of ______
Site Name______
Address______
Schools Served by the Central Kitchen:
If Equipment FundedSchool Name / % Free and Reduced –
Oct 2009 / Total Lunches Claimed in 2008-09 / Number of Students to benefit / Increase in Lunch
Meals / Increase in Breakfast
Meals
Page 1 of 2
Central Kitchen Equipment Grant Application
Application Page ______of ______
Provide a brief equipment description and cost (e.g., walk-in freezer, two-door refrigerator)
1. Equipment Description: $______
______
q New / q Replacement / q RenovationFocus of Equipment Purchase: (check all that apply)
q Improving meals to meet Dietary Guidelines
q Improving food safety
Provide food safety inspection to document need
q Improving energy efficiency
q Expanding participation
How will the listed equipment meet the area(s) of focus checked above?
Use as additional pages as needed.
Page 2 of 2