Only nonprofits, churches, and schools within at least a 50% free and reduced lunch area will be accepted. Attach 501(c)3 to this application. Are you currently a Kids Cafe?*YesNoSite Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mailing Address (if different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Site Supervisor* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Supervisor Title* Supervisor Phone*Supervisor Email* Date of Birth* MM slash DD slash YYYY Site Contact Check if same as Site Supervisor Site Contact* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Site Contact Title* Date of Birth* MM slash DD slash YYYY Site Contact Email* Site Contact Phone/Alternate Number*Are you a licensed childcare facility?*YesNoWill students receive academic credit?*YesNoMonths to serve:* Select All January February March April May June July August September October November December Days of week to serve:* Select All Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekends are not available to all sitesNumber of youth enrolled:*Start date for School Year* MM slash DD slash YYYY Who will you serve?* Open to all youth Enrolled only Number of suppers to be served daily:*Supper Start Time* Hours : Minutes AM PM AM/PM Supper End Time* Hours : Minutes AM PM AM/PM List all enrichment activities you provide:*If you have completed the enrichment form, put N/A in the box and upload the form with this application (Supporting Documentation.)Why would your site be a good location for a Kids Cafe? What would make it successful?*List any planned closures (including holidays):Comments:Supporting Documentation Drop files here or Select files Max. file size: 50 MB. Nonprofit status, Program Descriptions, Enrichment Form, Etc.