Healthy Meals Program Site Application
United Way California Capital Region

Form

Please fill out all information below.

SITE INFORMATION
Time of the day your site is in operation

Click each day of the week your site is in operation, and then select start and end time associated with each day.

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MEAL SERVICE INFORMATION
MEAL SERVICE START AND END TIMES

Serving time may vary throughout the week, but serving schedule must be followed. NOTE: If you’re filling out for Summer Meals program, please indicate start and end times for both meal times, if you’re planning for two meals.

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Please list all minimum days and site closure days (include special meal service times if applicable). If attaching site calendar, please type “Calendar attached,” in the box above.

DELIVERY INFORMATION

Include: Where to park, who to ask for, any other special instructions

FINANCIAL INFORMATION

Please list name and title

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