School Pantry Interest Form

School Name:*

Grades Served:*

Address:*

Street Address Address Line 2 City 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*

This field is hidden when viewing the form

Free & Reduced Percentage

How 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?

School Pantry Interest Form

School Pantry Application