SFSP Pre-Eligibility Form 150803

SFSP Pre-Eligibility Form
Legal Name of your Organization *
DBA Name
Type of Agency *
Type of SFSP Organization *
County *
DUNS Number *
Employee Identification Number (EIN):
A sole proprietorship that has no employees and files no excise or pension tax returns is the only business that does not need an employer identification number.
Contact Name *

First Name Last Name
Contact Title *
Contact Phone Number *

Area Code Phone Number
E-mail *
Does the Organization already participate in another nutrition program administered by TDA *

Yes No
For any questions regarding the program or to request a paper application, please call (877) TEX-MEAL.
Should be Empty: