Summer Meals Change Request Form

Summer Meals Programs "Change Request Form"

Everett Public Schools Food & Nutrition Services
This Change Form is to be used by Summer Sites seeking to make modifications to their original Summer Meals application. It may take up to 7-days for a change form to recieve approval. Summer Meals sites may not alter their service days, service times, or approved meal counts prior to OSPI authorization.

All fields are required to be completed. Incomplete forms will not be reviewed.

If you have any questions, please call the F&N Office at: (425) 385-4380
STEP 1: SITE INFORMATION
Site Name*
Contact Person*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
STEP 2: REQUEST A CHANGE

All Sites must have an APPROVED Summer Meals Application before requesting a change. If you have not yet received an approval - STOP - Call the F&N Office for assistance (425) 385-4380. Multiple changes may be included on the same form and will be reviewed individually.
My Summer Meals Site needs to adjust the following:*

(Regular) Days of Operation(Regular) Hours of Meal Service(One Time) Request a Field Trip - *requires 7-days notice*(One Time) Request a Holiday Closure or Non-Service DayUpdate Average Daily Participation (ADP)
When will this change start?*

MonthDayYear
Date
NEW Days of Operation*

MondayTuesdayWednesdayThursdayFriday
Update Breakfast?*

YesNo
NEW Breakfast Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
NEW Breakfast Count*
Update Lunch?*

YesNo
NEW Lunch Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
NEW Lunch Count*
Enter Non-Service or Holiday Start*

MonthDayYear
Enter End Date

MonthDayYear
Not required if asking for a single day
Will you be taking field trips that require meals (field trips are any meals served off site)?*

YesNo
Field Trip Date*

MonthDayYear
Complete OSPI's Field Trip Notification Form by pasting the following link into your search bar. Then upload the confirmation form below. https://www.surveygizmo.com/s3/4119591/Field-Trip-Notification*

Cancelof
Add any special notes below:
Changes are not approved until Authorized by OSPI.

Please allow for up to 7-days for the approval process to be completed. Field trips require at least 7-days notice.

Questions about completing this form, call the Food and Nutrition office at 425-385-4380 or email foodservices@everettsd.org.
Should be Empty:

Summer Meals Programs "Change Request Form"

STEP 1: SITE INFORMATION

STEP 2: REQUEST A CHANGE