PART III – REQUIRED PROGRAM INFORMATION

Please complete the required program information below for each school/ site applying for grant funds.

I.	School Information

1. School District:	Agreement Number:

2. School Name:	Site Number:

3. School Address:

4. Did this school receive a School Nutrition Equipment grant in 2010 (ARRA), 2011 (USDA), or FY14, FY15, FY16, FY17, FY18, FY19 (USDA)?	Yes No

II.	School Data (ESE will verify this data)

1. Total enrollment data (use October 2018 claim data)

Enrollment as of October 2018:

Number of students approved/ eligible for free meals:

Number of students approved/ eligible for reduced meals:

Percentage of free and reduced-priced eligible students as of October 2018:

2. Grade levels for the site applying:

3. Meals offered (check all that apply):
SBP NSLP Afterschool Snack CACFP At Risk Meals Summer Meals Program

4. How would you describe the school’s location? (check one): Urban Rural Suburban

5. Is this school an approved Summer Food Service Program (SFSP) feeding site? Yes No

If yes, is the site a SFSP central kitchen? Yes No

6. Does this school participate in the Community Eligibility Program (CEP)?	Yes No

7. Does this school participate in Provision 2?	Yes No
If yes, for: NSLP SBP Both NSLP and SBP

III.	Proposal	Site Name:

Describe briefly the equipment and how the school plans to address any or all of the following focus areas (if requesting the purchase of more than one piece of equipment, please attached additional proposal information as needed):

Submit the name of the piece(s) of equipment that the grant funds would purchase for the school.

Provide copies of support documentation that includes the prices for each piece of equipment as found in Chapter 30B (Uniform Procurement Act). (Please note: a piece of equipment must have an acquisition cost of $1,000 or more):

Type of equipment requested, in order of preference	Cost

Total Grant Amount Requested

Please answer the questions below. Please be detailed in your responses. Each question is worth a separate number or points on the scorecard for the grant reviewers.

How will the equipment allow the SFA to support and sustain school breakfast and lunch program expansion?

b.	How will the equipment lend itself to improving the nutrition and quality of school food service meals that meet dietary guidelines (e.g., purchasing an equipment alternative to a deep fryer)?

c.	How will the equipment improve the safety of the food served in the school meals program?

d.	How will the equipment improve overall energy efficiency (consider age of current food service equipment)?

IV.	Staffing Information	Site Name:

Contact information of person responsible for overseeing the grant:

Name:
Title:
Email address:
Phone number:

V.	Signatures

We have reviewed this application and attest to the information provided. If selected, we agree to implement the program as outlined above and to implement the project in a manner consistent with the policies and the procedures established by the USDA.

We attest that the School Food Authority (SFA) is in good standing with the Child Nutrition Program reporting requirements.

We attest that the funds will be used to purchase equipment for the implementation of the School Nutrition Program in (and only in) the specific school requesting the grant.

We have provided copies of support documentation that includes the prices for each piece of equipment we are requesting as found in Chapter 30B (Uniform Procurement Act).

We agree to participate in any USDA sponsored evaluations, and to provide the information requested by the specified deadlines.

We will tag all equipment purchased with a label identifying it as being purchased with FY20 USDA School Nutrition Assistance Grant Funds.

I hereby certify that the LEA duly solicited three quotes for each piece of equipment requested and has adhered to all Federal, State, and Local procurement laws and standards, including, if applicable, as found in 7 CFR Part 210.21 and 2 CFR 200.317 through 2 CFR 200.326

Please provide the contacts shown below or equivalent positions as determined by the school.

School Nutrition Director:	Date:

Superintendent or Executive Director:	Date: