Special Assistance Provision 2/3 Base Year Application

* required field

Please review the Special Assistance Guidance Manual. After reviewing the manual, if you would like to apply for the Special Assistance Program, please complete this application. Once completed, submit this webform for review. Please note that this application is not approved until you receive an official letter of approval from this department. Approval letters are sent in June of each year prior to the start of the school year. This application is due no later than June 30th annually.

LEA Information
Applying sites (as shown in CNPWeb)
List the legal name of applying sites (as shown in CNPWeb)
Select site's meal participation
Second Site
Select site's meal participation
Third Site
Select site's meal participation
Fourth Site
Select site's meal participation
Applying sites (as shown in CNPWeb) File Upload
List the legal name of applying sites (as shown in CNPWeb)
Please list site name(s) below, or indicate that a list of all sites is attached (if applying for more than four sites). The list needs to indicate the fields shown below on School District Letterhead.
  • Legal name of applying sites (as shown in CNPWeb) 
  • Base Year 
  • Participation in BREAKFAST (B), LUNCH(L),OR BOTH (BL)
Requirements
I CERTIFY
I CERTIFY that the information in this application is true, and that I agree to carry out the terms of the agreement to operate the Special Assistance Program. I understand that this information is given in connection with the receipt of federal funds and that deliberate misinterpretation may be subject to prosecution under applicable federal statutes.