After School Snack Program - SY 10

After School Snack Program - SY 16 Registration Form

Date Submitted Please fill out the required information and fax or email to Condus Shuman, Nutrition Program Specialist, Nutrition Administration - phone (404) 802-2541; [email protected] or fax (404) 802 1502.

School:

Principal:

Program Name:

Type of Program: Homework Assistance/After-School Care Tutorial and After-School Care

Number of Students to be served: Student Grade Levels:

Projected Program Schedule: M T W TH F Hours of Operation: (Please check all days that snacks are to be served)

After School Program Coordinator: (Staff Name to receive required training from the School Nutrition Department Staff)

Email Address:

Telephone Number:

Projected Start Date of After School Program:

Projected Stop Date (Last Day of Program):

Please initial by each item below indicating expected compliance to all APS Afterschool Snack Program Guidelines:

____ Snack registration form for each program must be submitted 3 weeks prior to the expected date of service.

____ Required training must be completed by each After School Program Coordinator prior to the expected date of service. Meal service will begin 3 weeks after the completion of training.

____ Snacks must be picked up from the Cafeteria Manager by the After School Program Staff by 3:00 PM

____ Student Serving Rosters must be maintained daily by the After School Program Staff and given to the Cafeteria Manager for all students receiving snacks.

____ Notification of program cancellation must be provided 2 weeks prior to the last day of the program

____ The Afterschool Program will be responsible for the cost of any prepared snacks that are picked-up for scheduled student meal service. For School Nutrition Department Use Only:

Date Received ______SY15 Free and Reduced Rate______

Date Training Complete______Start Date of Snack Service ______