This form is for the school site coordinator to report monthly totals, success stories and concerns/needs for the Food 4 Kids Backpack Program.

Please submit your information no later than on the 5th day following the reported month. If you have any questions or need help submitting the form, please contact:

Daniela Solano

    1. Report for the Month of:
    2. (required)
    3. Year:
    4. (required)
    5. School Site:
    6. (required)
    7. (required)
    8. (required)
    9. (valid email required)
    1. Week 1:
    2. Week 2:
    3. Week 3:
    4. Week 4:
    5. Week 5:
    For the following questions below, please share the impact the Food 4 Kids Backpack Program has had on one of your student participants.