Application to launch a Meals On Wheels for Kids (MOW4Kids)

Agreements

*Required field

We affirm that our Organization meets all of the following eligibility requirements to apply (check all that apply)*:

Located in eastern United StatesIs a registered and active 501c3 nonprofit organization in the United States or a school, for a minimum of three years (attach proof-501c3 certificate)Has an active home-delivered meal program, preferred (attach program description below, including mission, number of people served, delivery model, website, flyers for program, etc.)Serves communities without adequate access to transportation (as described in more detail below)Has a demonstrated need for the program (as described in more detail below)Demonstrated collaboration with network partners to avoid duplication of service (as described in more detail below)Embrace and employ non-discrimination policies (attach policy below)Volunteer board of directors (attach list of board members and affiliations below)

Non Discrimination Policy

*Required field

Tampa Bay Network to End Hunger is committed to equal opportunity for all persons regardless of race, color, national origin, religion, sex, sexual orientation and gender identity, age, disability, or any other legally protected status. It is our intent to consider requests only from organizations and agencies that pursue these same principles in their governance, employment practices, and services.

Attach your agency’s non-discrimination policy that covers everyone in the organization – staff, board, volunteers, and the people you serve – and that offers a clear commitment to non-discrimination across all legally protected communities.*

Terms and Conditions

Please carefully review, and agree to, the Terms and Conditions for participation in the MOW4Kids program.*

Yes, I have read, and agree to, the Terms and Conditions.

Electronic Agreement and Signature

*Required field

By entering my name and date below, I consent to the use of an Electronic Agreement and Signature and indicate by agreement to the Terms and Conditions.*

Full Name*: Date*:

Photo/Video Release Form

It is the organization's obligation to obtain, and hold, a valid photography or recording release for any/all persons or organizations that may be identified in any photo or other content, such as recording. This release form must be submitted upon request from Tampa Bay Network to End Hunger.*

I agree to provide a Photo/Video Release Form upon request from Tampa Bay Network to End Hunger.

Organization Information

*Required field

Name of Organization*:EIN*:

Address*:

City*: State*:

County*: Zip*:

Website*: Phone*:

Annual Budget*: Attach current fiscal year budget*:

Organization Description/Background/Mission Statement*:

Board of Directors/Advisory Board* (Include current board of directors and their affiliated organizations. You may type below or attached the file.)

Designated Contact Person

*Required field

First Name*

Last Name*

Title*

Phone*

Email*

Please upload a bio for the contact person.*

How did you learn about MOW4Kids?*

CEO, Executive Director, or President

*Required field

First Name*

Last Name*

Title*

Phone*

Email*

Please upload a bio for the Executive Director.*

Program Information

*Required field

1. Describe the issues or challenges children experience in terms of hunger when opting to learn remotely due to COVID-19 in your community.*

2. Describe how launching a home delivered meal service program, like MOW4Kids, to serve children who have opted to learn remotely due COVID-19, will help improve childhood hunger and nutrition.*

3. Describe what your organization may need to help facilitate the launch of a home delivered meal service program, like MOW4Kids. Be specific as possible.*

4. How many children and households are you aiming to serve?*

5. What proportion of children have opted to attend school remotely in your county?* (example 30,000/120,000 kids)

6. What percent of children participate in the National School Lunch Program in your county?*

7. What percent of children are receiving meals through the grab and go distribution at schools?*

8. List and describe the communities that will be served by your program? (must include name of city, specific zip codes you plan to serve, public transportation options, and describe if it is rural (more than 10 miles from a grocery store) vs urban (less than 10 miles from a grocery store).*

9. Do the communities listed above have access to adequate transportation? Please describe.*

10. What is your staff’s capacity to launch a MOW4Kids program? Describe who would lead this effort, as well as other team mates, how many hours will be dedicated to the program each week, and the point of contact if different than the lead.*

11. Has your organization made an effort to raise funds to support the development of a home delivered meal program to serve homebound children and their families, like MOW4Kids?*
YesNo

If you answered yes, please describe your efforts and include the amount you have raised to date.

12. What does your organization hope to achieve with a home delivered meal program, like MOW4Kids. Include a program goal and brief description of 1-2 objectives.*

13. List other organizations, if any, you are working with on this project and the role of each.*

Other supporting documents

Upload any additional or supporting documents here

Requirements

If awarded support, I understand I will be required to:
• Carry out the terms of the agreement within six (6) months of award letter (or later if approved in writing), and solely for the purpose(s) approved in the award letter.
• Submit interim and final reports that describe and give updates on program implementation, progress to goals, observations, and participation numbers. Specific grant reporting requirements will be communicated at the time of award notification.
• Assist coordination of a representative from Tampa Bay Network to End Hunger to visit my program at a convenient date(s) to see my home delivered meal program in action.
• Work with a representative from Tampa Bay Network to End Hunger to publicize the awarded support and how it has contributed to the success of my home delivered meal program.
• Understand that awarded support may be funded through corporate partners working with Tampa Bay Network to End Hunger, the founder of Meals On Wheels for Kids. You will be notified immediately if corporate partners are sponsoring this opportunity.

Acknowledgement and Agreement

By submitting this form, we certify that our Organization meets the eligibility requirements listed above (and in other supporting materials) as of the date identified below and will continue to meet the requirements for the Term of the Agreement outlined in the Terms and Conditions. We affirm that the information provided herein is accurate and truthful, and that we have read, understand and agree to the Terms and Conditions. We acknowledge and agree that our request for assistance may not be approved in whole or in part, that the decision of Tampa Bay Network to End Hunger is not reviewable or appealable, that support may only be used for the purposes stated herein, and that any supporting funds not used from the designated purposes are due back to Tampa Bay Network to End Hunger.

Name of Executive Director/Chief Executive Officer/President

Name of person submitting application

Title

Date

I am, or have the power to act on behalf of, the Executive Director, President or CEO of this organization and have authority to bind the Organization/Applicant to the terms and conditions contained herein.
YesNo