2023 Summer Feeding Application Application must be completed in one sitting. Please ensure that you have all of the required documents and allow 15 - 20 minutes to complete.Have you ever partnered with GCFB for any of our Children's Meal Programs?* Yes No Organization/Agency Name*-----ACE Ohio WellnessAdvantage Cleveland Tennis and Education, Inc.AIDS Taskforce of Greater ClevelandAlliance For Family HopeApplewood CentersAvenue Youth Inc.Beat The Streets ClevelandBedford Parks and Recreation-EllenwoodBedford ReservationBellaire Puritas P4SS Artemus WardBellefaire JCB-ASP Building HBellefaire JCB-SBC - Building DBoy and Girls Club-FDRBoys and Girls Club- King KennedyBoys and Girls Club- StepstoneBoys and Girls Club-BroadwayBoys and Girls Club-East Tech Teen CenterBoys and Girls Club-EuclidBoys and Girls Club-GarfieldBoys and Girls Club-St. LukesBoys and Girls Club-St. Martin de PorresCathedral Church of God in ChristCCPL-Brook Park BranchCCPL-Brooklyn BranchCCPL-Garfield Heights BranchCCPL-Maple Heights BranchCCPL-North OlmstedCCPL-Parma BranchCCPL-Parma Heights BranchCCPL-Parma- Snow BranchCCPL-South Euclid-Lyndhurst BranchCCPL-Southeast BranchCCPL-Warrensville BranchCH-UH Library- Lee Road BranchCH-UH-Noble BranchChagrin Falls Park Community CenterChanging Lives MinistriesChurch Of God and Saints of ChristCitizens AcademyCity of Mansfield Parks & Recreation DeptCity of Mansfield Parks & Recreation Dept-Burton ParkCity of Mansfield Parks & Recreation Dept-Johns ParkCity of Mansfield Parks & Recreation Dept-North Lake ParkCity of South Euclid-Garfield Memorial ChurchCleveland MetroparksCleveland Metroparks-Bedford ReservationCleveland Metroparks-Euclid BeachCleveland Metroparks-Euclid Creek ReservationCleveland Metroparks-Garfield ParkCleveland Metroparks-Lakefront ReservationCleveland Play House- DowntownCleveland Public TheatreCMHA-Lakeview Community CenterCMHA-Outhwaite Homes AfterschoolCMHA-RiversideCMHA-Woodhill Community CenterCollaborative Community ServicesCPL-Addison BranchCPL-Brooklyn BranchCPL-Carnegie West BranchCPL-Collinwood BranchCPL-East 131st BranchCPL-Eastman BranchCPL-Fleet BranchCPL-Fulton BranchCPL-Garden Valley BranchCPL-Glenville BranchCPL-Harvard- Lee BranchCPL-Hough BranchCPL-Jefferson BranchCPL-Langston Hughes BranchCPL-Lorain BranchCPL-Main BranchCPL-Martin Luther King Jr BranchCPL-Memorial- Nottingham BranchCPL-Mt. Pleasant BranchCPL-Rice BranchCPL-Rockport BranchCPL-South BranchCPL-South Brooklyn BranchCPL-Sterling BranchCPL-Union BranchCPL-Walz BranchCPL-West Park BranchCPL-Woodland BranchDepression Bipolar Support Alliance Northeast OhioE.B.C. Senior CenterEast Cleveland Neighborhood CenterEast Cleveland Public LibraryEsperanzaEuclid Beach ParkEuclid Creek ReservationFairhill PartnersFatima Family CenterFirst English Lutheran Church E.L.C.Foluke Cultural Arts Center, IncFriendly Inn Settlement, Inc.Garfield Park ReservationHoly Trinity Baptist ChurchHorizon-Global Ambassadors Language AcademyImpact Youth Incorporated-L.E.A.D Summer ProgramJBS Lunch and Literacy Outreach Center For KidsKA-LA Healing Garden CenterKenneth W. Clement Boys Leadership AcademyLakefront ReservationLakewood City SchoolsLiving Hope Community ChurchLiving Truth Center for Better LivingLoudonville Public LibraryMansfield UMADAOPMarvelous Faith Ministries, Inc./DBA 3MB AfterschoolMerrick HouseMetroHealth- Broadway Health CenterMetroHealth- Zubizarreta HouseMetroHealth-Buckeye at Alpha HouseMetroHealth-Peds WellnessNeighborhood Leadership Institute (True2U)New Beginning MinistriesNew Life Community Development CorporationNew Mercy Outreach IncNorthen Ohio Recovery AssociationNottingham United Methodist ChurchOlivet Institutional Baptist ChurchPink Party Retreat-St. JohnsPrincess Endowment Inc-Field Strong Summer CampQueen IAMRainey InstituteRight Direction Health and Behavioral ServicesSalvation Army- East ClevelandSalvation Army- West ParkSalvation Army-Dewald Community CenterSalvation Army-Miles ParkSalvation Army-Temple CorpsScranton Road Ministries C.D.CSevynteenth FoundationShiloh Temple House of GodSOS: Strengthening Our StudentsSt. John Baptist ChurchSt. Matthew United Methodist ChurchStaci TestTeam Couture Youth CenterThe Historic Greater Friendship Baptist ChurchThe Meeting Place PreschoolThe People's Safe Haven-Friends Fellowship Bible ChurchThea Bowman CenterUniversity Circle Inc.University SettlementVillage Prep School CliffsWashington Park Community SchoolWillow Praise ChurchOrganization/Agency Name*if multiple locations are being used, please put the name of the actual site Address*This address should reflect the location where the meal is being served. Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide your 4-digit zip code extension:*Note: Please just enter the 4 numbers of the extension. This is required for the state application. Please do not enter incorrect information. You can find this information by copying and pasting the website link into another tab on your web browser: https://tools.usps.com/go/zip-code-lookup.htmCounty*AshlandAshtabulaCuyahogaGeaugaLakeRichlandNearest cross street:*For example: Mayfield Rd / Warrensville Rd. Is your program held in a "nut free" facility?* Yes No UploadsPlease upload your signed Site Sponsor Agreement Form*If you do not currently have this form, please download it from the Summer Feeding page, sign it, then upload it here.This file must be a PDF Here is a link to the form that you can copy and paste into another tab in your web browser: https://portal.clevelandfoodbank.org/programs/wp-content/uploads/sites/4/2023/02/Sponsor-and-Site-Agreement-Form-Signed.pdfMax. file size: 49 MB. Please upload the signed Addendum to the Site Sponsor Agreement Form*This file must be a PDF Here is a link to the form that you can copy and paste into another tab in your web browser: https://portal.clevelandfoodbank.org/programs/wp-content/uploads/sites/4/2023/02/Addendum-to-Separate-Entity-Agreement-1-13-2023.pdfMax. file size: 49 MB. Please upload the signed Participation Agreement Form*This file must be a PDF Here is a link to the form that you can copy and paste into another tab in your web browser: https://portal.clevelandfoodbank.org/programs/wp-content/uploads/sites/4/2023/02/SFSP-Participation-Agreement-_1-13-2023.pdfMax. file size: 49 MB. Please upload the Background Check Document*This file must be a PDF Here is a link to the form that you can copy and paste into another tab in your web browser: https://portal.clevelandfoodbank.org/programs/wp-content/uploads/sites/4/2023/02/Background-Check-Form_revised-1-31-2023.pdfMax. file size: 49 MB. Is your program a non-profit organization?* Yes No Is your program held in a federal building, school building, or library?* Yes No Do you have a fiscal agent?* Yes No Please upload your Proof of Non-Profit Status*This file must be a PDFMax. file size: 49 MB. Please upload a file containing your Summer Calendar to include all days open/closed for meal service*All submissions must be submitted using the template provided and must include: name of primary contact, branch name if applicable, phone, e-mail and signature. Documents on letterhead are preferred, but not required.This file must be a PDF Here is a link to a template - you can copy and paste this into another tab in your web browser for download: https://portal.clevelandfoodbank.org/programs/wp-content/uploads/sites/4/2023/02/SFSP-FY23-Calendar.pdfMax. file size: 49 MB. Staff and FacilityCEO/Principals/Pastors (person in charge) Name* CEO/Principals/Pastors (person in charge) Email* CEO/Principals/Pastors (person in charge) Phone #*Administrator Contact* Email* Phone #*Alt. PhoneAdministrator Contact's Date of Birth*This is a new requirement from the State. MM slash DD slash YYYY On-Site Supervisor (must be different from CEO and administrator)*This is the person who will be on-site during meal service Email* Phone #*Alt. PhoneOn-site Supervisor's Date of Birth* MM slash DD slash YYYY Number of Volunteers/staff involved in the program* Summer Feeding ProgramAge range of the children served in your program:*Select all that apply Pre-School (3-5 years old) School Age (6-18 years old) What kind of activities do you provide for the children?* Length of ProgramThe 2023 SFSP will operate Thursday, June 1st - Friday, August 11th. Please be prepared to receive your first meal delivery on Wednesday, May 31st as SFSP meals are delivered a day in advance. 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 the number of open/operating days for each month of participation. To avoid delays in processing your application, please ensure that this number is accurate.Anticipated start date:* MM slash DD slash YYYY Anticipated end date:*(Your program must end on this date or provide a 2 weeks notice if your end date changes) MM slash DD slash YYYY Note: If either of these dates change without a two-week notification, sites will be invoiced for the returned meals including a delivery fee. Cancellation without proper notification may result in termination of future meal service. Number of operating days in June*Please indicate the number of "open" days in June. If zero, enter "0". Number of Operating Days in July*Please indicate the number of "open" days in July. If zero, enter "0". Number of Operating Days in August*Please indicate the number of "open" days in August. If zero, enter "0". What is your geographic location?* Rural Urban Was your organization a Summer Feeding site with us for the Summer of 2020?* Yes No Site type:*At least 50 percent of the enrolled children at the site must be eligible for free or reduced-price school meals. Most often, sites operate as "open." Please know that if you choose "closed", or "open restricted," you must provide a statement of reason and final approval to operate this type of site will be decided by ODE. Open - open to the community Open Restricted - open to the community, but limited due to space, safety, security, or to maintain control. CANNOT RESTRICT to only certain groups of children Closed Enrolled - closed entrolled sites must also establish Closed Enrolled - Closed enrolled sites must also establish the eligibility either through the individual income eligibility of the children attending the site or through area eligibility. To establish eligibility based on the income of the individual children; sites must collect household applications. Statement of Reason*Please provide a statement indicating why your site will not be open to the community. Area Public SchoolsThis helps us determine program eligibility. Please ensure to enter the information exactly as it appears on the MR81. This is required for the state application and must be accurate. Please enter the information exactly as it appears. School District:* Please list the closest elementary school:* Please provide the Percentage of Free and Reduced Priced Lunch Enrollment for this school:*You can find this information by downloading the "MR81 Document" on the Portal Summer Feeding Page.Please list the closest middle school:* Please provide the Percentage of Free and Reduced Priced Lunch Enrollment for this school:*You can find this information by downloading the "MR81 Document" on the Portal Summer Feeding Page.Please list the closest high school:* Please provide the Percentage of Free and Reduced Priced Lunch Enrollment for this school:*You can find this information by downloading the "MR81 Document" on the Portal Summer Feeding Page. Describe your facility:Number of refrigerators*Do you have the ability to store Summer Feeding food separate from other food items?* Yes No Do you have the capability to store meals overnight?*Summer Feeding meals are delivered the day before meal service. Meals must be stored safely at the proper temperature until meal service. Yes No Meal ServicePlease select the available meal type below:* Cold Meals Combo Meals Select the meals you'll be serving (select all that apply)*Breakfast – minimum number of breakfast meals is 20 meals per day, at a minimum of 2 days per week. Lunch – minimum number of breakfast meals is 20 meals per day, at a minimum of 2 days per week. Please note that if you chose to serve both breakfast and lunch, there must be minimum amount of 3 hours that must pass between meals. Breakfast Lunch What time will you serve breakfast?*Please enter your start/stop time. Reminder: meal periods cannot exceed one hour. Example: 8:00 am - 9:00 am Will you serve breakfast on Saturday?* Yes No What time will you serve breakfast on Saturday?*Please enter your start/stop time. Reminder: meal periods cannot exceed one hour. Example: 8:00 am - 9:00 am Monday Breakfast Meals Requested:*Enter '0' if meals are not being served.Tuesday Breakfast Meals Requested:*Enter '0' if meals are not being served.Wednesday Breakfast Meals Requested:*Enter '0' if meals are not being served.Thursday Breakfast Meals Requested:*Enter '0' if meals are not being served.Friday Breakfast Meals Requested:*Enter '0' if meals are not being served.Saturday Breakfast Meals Requested:*Enter '0' if meals are not being served.What time will you serve lunch?*Please enter your start/stop time. Reminder: meal periods cannot exceed one hour. Example: 12:00 pm - 1:00 pm Will you serve lunch on Saturday?* Yes No What time will you serve Lunch on Saturday?*Please enter your start/stop time. Reminder: meal periods cannot exceed one hour. Example: 12:00 pm - 1:00 pm Monday Lunch Meals Requested:*Enter '0' if meals are not being served.Tuesday Lunch Meals Requested:*Enter '0' if meals are not being served.Wednesday Lunch Meals Requested:*Enter '0' if meals are not being served.Thursday Lunch Meals Requested:*Enter '0' if meals are not being served.Friday Lunch Meals Requested:*Enter '0' if meals are not being served.Saturday Lunch Meals Requested:*Enter '0' if meals are not being served. Delivery Window*Please choose the preferred 2 hour delivery window between 9 am and 3 pm. Reminder: SFSP meals are delivered a day in advance. 11 am - 1 pm 12 pm - 2 pm 1 pm - 3 pm Any additional comments about meal time or quantity? Please select all supplies needed for Meal Service:* Probe thermometers Hanging thermometers Gloves Napkins Plates Forks Spoons Demographics at Your CenterProvide percentage breakdown of population by racial/ethnic category for your enrollment. (You must enter a number 0-100 in each box.)% American Indian or Native Alaskan*Please enter a number from 0 to 100.% Asian*Please enter a number from 0 to 100.% Black or African American*Please enter a number from 0 to 100.% Native Hawaiian or other Pacific Islander*Please enter a number from 0 to 100.% White*Please enter a number from 0 to 100.% Hispanic or Latino*Please enter a number from 0 to 100.% Total*Total must be equal to 100. Demographics in the Area Served by Your CenterProvide percentage breakdown of population by racial/ethnic category for the surrounding area. (You must enter a number 0-100 in each box.)% American Indian or Native Alaskan*Please enter a number from 0 to 100.% Asian*Please enter a number from 0 to 100.% Black or African American*Please enter a number from 0 to 100.% Native Hawaiian or other Pacific Islander*Please enter a number from 0 to 100.% White*Please enter a number from 0 to 100.% Hispanic or Latino*Please enter a number from 0 to 100.% Total*Total must be equal to 100.NameThis field is for validation purposes and should be left unchanged.