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SFSP-Application
SFSP-Application
Mike Stafford
2025-01-29T17:57:26-05:00
Summer Food Service Program (SFSP) Site Application 2025
Organization Name
(Required)
Address
(Required)
This address should reflect the location where the meal is being served.
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County
(Required)
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
Mckean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Staff and Facility
(if you have more than one location, please fill out an application for each location)
Administrator/CEO/Principal/Pastor (Person In Charge)
(Required)
First
Last
Title
Administrator Email
(Required)
Administrator Main Phone
(Required)
Administrator Alternate Phone
(Required)
Site Supervisor Name
(Required)
This is the person who will be on-site during meal service. If this person is unknown at the time of application, please use the name of the primary contact for the site in the meantime and notify us immediately when the position is filled.
First
Last
Title
Site Supervisor Title
(Required)
Site Supervisor Email
(Required)
Site Supervisor Alternate Phone
(Required)
Site Supervisor Main Phone
(Required)
Eligibility Determination
This helps us determine program eligibility. This is required for the state application and must be accurate.
School District
(Required)
Please list the closest elementary school:
(Required)
Was your organization sponsored by the Food Bank for the Summer Food Service Program in a previous summer?
(Required)
Yes
No
Does the Food Bank currently sponsor meals for an afterschool program at your site?
(Required)
Yes
No
Summer Feeding Program
Age range of the children served in your program
(Required)
Select all that apply
Pre-School (3-5 years old)
Primary School Age (6-12 years old)
Teens (13-18 years old)
Select All
Length of Program
The 2025 SFSP will operate June 9th thru August 22nd. If you are serving breakfast, please be prepared to receive your first meal delivery on the weekday prior to your first day of service as breakfast meals will be delivered a day in advance (with very few exceptions). The state application requires that we provide the number of operating days for each month of participation. Please review your calendar and advise of your program start and end dates, as well as any days you will not need to receive meals.
Anticipated start date:
(Required)
Date must be June 9th or later.
Month
Day
Year
Anticipated end date:
(Required)
Date must be on or before August 22nd. Your program must end on this date or provide one week notice if your end date changes.
Month
Day
Year
Which days of the week will you serve food?
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Select All
Closed Dates
List all dates between your start and end date that you will not need to receive meals. Note: We are closed on Wed, June 19th and on Friday July 4th. No meals will be offered on those dates.
Field Trips
List all dates and locations of field trips. Please give us 48 hours noticed for any new field trips added during the summer.
Describe your facility:
Do you have the capability to store refrigerated meals overnight?
(Required)
Hot meals (in individual trays) will need to be heated prior to serving. Meals must be stored safely at the proper temperature until meal service.
Yes
No
Number of full-size refrigerators
(Required)
Full-size refrigerators include both household and commercial grade refrigerators. Do not include apartment-size refrigerators in your total count.
Please enter a number from
0
to
6
.
Do you have a working sink available on site?
(Required)
Yes
No
Select the meals you'll be serving (select up to two meal types in any combination except lunch and dinner)
(Required)
Please note that you cannot serve both Lunch and Dinner meals. Meal types can be changed during the summer if needed but can only be changed on the first serving day of the month.
Breakfast
Lunch
Dinner (must be available for daytime delivery)
Meal Times:
Please list what time meal service will begin and end.
Delivery Instructions
Please describe any special delivery instructions (e.g. entrance to use, where truck can park).
Any additional comments about delivery window, mealtime or quantity?
Please Select a date for virtual training (all sites must attend training before they can begin meal service.)
(Required)
May 23rd 3pm
May 27th 9am
May 28th 11am
May 29th 3pm
Δ
If you are having problems completing the form above, please reach out to our
Youth Programs Team
(717)724-3192
or
dlattanzio@centralpafoodbank.org
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