SFSP Intake Form 150803

SFSP Intake Form
Legal Name of your Organization
Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
DBA Name
Type of SFSP Organization
Enter number of sites:
UEI Number
All entities wishing to do business with the federal government musthave a unique entity identifier (UEI). See SAM.gov for more details.
Employee Identification Number (EIN):
Background checks will be completed for all potential applicants.
Contact Name

First NameLast Name
Contact Title
Contact Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearEnter Date
Contact Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number

Area CodePhone Number
E-mail
Does the Organization already participate in another nutrition program administered by TDA
Contracting Entity Identification Number:
Provide if already operating a TDA food program such as SNP or CACFP.
For any questions regarding the program or to request a paper application, please call (877) TEX-MEAL.
Should be Empty: