School Name:* Grades Served:* Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Principal Name* First Last Pantry Coordinator Name* First Last Position:* Coordinator's Email* Coordinator's Phone*Average Enrollment*Schools Free & Reduced Percentage* HiddenFree & Reduced PercentageHow many students/families do you anticipate serving each month?*Do you receive any of the following or already have any of the following?* Blessings in a Backpack School Pantry Other None Please describe your program listed above and why you want a school pantry or need additional assistance.How many students would you consider to be chronically hungry at your school?*Where is your pantry currently located? Is food safetly stored 6 inches off of the ground and away from the wall in a temperature control secure area? If not, what do you need to make it compliant?*Can you identify a space in the school that will respect student's privacy and store food safely? Please explain.*Is there a team of individuals invested both at the school and in the community to make the school pantry successful and sustainable? Please explain.*Who will you serve?* Enrolled Students Only Enrolled Students and their Families Enrolled Students at Nearby School(s) Open to the Community How will you serve the students? Check all that apply.* Select All Pre packaged bag/box Choice System (students shop) Pantry will have set open hours during school Pantry will have set open hours after school Pantry will be open as needed/requested Pantry will be open during the summer What will be the pantries hours of operation?* Do you have access to any of the following?* Cabinet Chest Freezer Commercial Refrigerator Commercial Freezer Standard Refrigerator/Freezer Locking Cabinet Shelving Other In need of additional storage options What types of items would you like to make available at the pantry? Check all that apply.* Frozen Produce Refrigerated Shelf Stable Would you like to offer school pantry during the summer?* Yes No Maybe If you could choose any items for your pantry, what would they be?What is your approximate School Year Food Budget?*Do you want to join/continue partnering with the CO-OP program (Food Purchasing Program)?* Yes No Dare to Care’s objectives for the development and offering of the Co-op program are as follows: • To provide quality products and cost savings to those DTC partner agencies that purchase food on a regular basis; • To offer an additional food source solution for DTC partner agencies, designed to provide convenience with regard to acquisition time and effort; • To leverage DTC’s access to national food source networks and truck load pricing to help partner agencies feed more people while increasing cost effectiveness; • To offer good quality, in-demand, staple food items that are not donated regularly to DTC. Please explain why a school pantry is needed in your school and/or what makes it successful.*Please share a story of a child and/or family that has been impacted by the program.*Please share ways you track or measure success of the program and any data found.Are you serving any additional schools/students/communities?