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
Enter 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*

YesNo
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: