<p> After School Snack Program - SY 16 Registration Form</p><p>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. </p><p>School: </p><p>Principal: </p><p>Program Name: </p><p>Type of Program: Homework Assistance/After-School Care Tutorial and After-School Care</p><p>Number of Students to be served: Student Grade Levels: </p><p>Projected Program Schedule: M T W TH F Hours of Operation: (Please check all days that snacks are to be served)</p><p>After School Program Coordinator: (Staff Name to receive required training from the School Nutrition Department Staff)</p><p>Email Address: </p><p>Telephone Number: </p><p>Projected Start Date of After School Program: </p><p>Projected Stop Date (Last Day of Program): </p><p>Please initial by each item below indicating expected compliance to all APS Afterschool Snack Program Guidelines:</p><p>____ Snack registration form for each program must be submitted 3 weeks prior to the expected date of service.</p><p>____ 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.</p><p>____ Snacks must be picked up from the Cafeteria Manager by the After School Program Staff by 3:00 PM</p><p>____ Student Serving Rosters must be maintained daily by the After School Program Staff and given to the Cafeteria Manager for all students receiving snacks.</p><p>____ Notification of program cancellation must be provided 2 weeks prior to the last day of the program</p><p>____ 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:</p><p>Date Received ______SY15 Free and Reduced Rate______</p><p>Date Training Complete______Start Date of Snack Service ______</p>