HomeMy WebLinkAboutNew Site InformationSummer Food Service Program
Internal Use Only
1 have checked the,following sources for
the attached new site (s)
Yes No N/A
Child Care Centers List
CNP Report SFSRP 2032 _
Closed Charters School List
Site Manager _
USDA National Disqualified List
Online Map (i.e. Map Quest for site
proximity)
4ew Site Information
2009
Internal Use Only
Approved By
Date
Site Number
Agreement Number: 04- 0 8 9 9
Sponsor Name: - Cit -of Miami Department of Parks and Recreation - —-------- -
New Site Name: Lemon City Park
Check Site Type: [x❑ Recreation ❑ School —1 Residential Camp ❑lion -Residential Camp
❑ Migrant ❑ Church ❑ Homeless ❑ Day Care ❑ NVSP ❑ CROP ❑ Upward Bound
Street Address:
City: Miami
Zip: 3 31 3 3
Phone: 305 759 -3512
E-mail:
Today's Date: 0 3/ 2 5/ 0 9
Name/Title of Person Adding Site: Gwendolyn Kitchen A s ' stant Sul2erintendent
How will you determine eligibility? ❑ Survey 3 ❑x Census Tract ❑ Other (specify):
NOTE: This form can be faxed or emailed to your Program Representative. If you choose to
submit this form to our office via e-mail, you will receive an e-mail confirmation that your form has
been received and is being processed.
REMINDER: Once your new site name has been added to the system a program representative will
email you the site number. Once verified by you, you can complete the site application process for
the new site(s). This site application must be approved by the State agency prior to meals
served and claimed at this site. If you should have any questions, please contact your program
representative at 1/800-504-6609 or via e-mail.
SUBMIT THIS FORM:
Via e-mail-.
bonna.salyers@fldoe.org Region 1
Wendy.rude@fldoe.org Region 2
Lisbeth.rytiewski@fldoe.org Region 3
Lori.ciszak@fidoe.org Region 4
Awilda.font@fldoe.org Region 5
Craig clemmer@fldoe.org Region 6
Lisarnarie.rodriguez@fldoe.org Region 7
Brenda.dekle@fldoe.org Region 8
Via Fax (850) 245-9276
SFSP-A15 Revised 3/12/09