Operation Frontline: Agency Application

This application is required for all new agencies and organizations that have not previously held a class series at their site. Please complete the following information and return this form via mail or fax to:

Becca Story Operation Frontline Coordinator

c/o The NH Food Bank, 62 West Brook Street, Manchester, NH 03101

Phone 603-669-9725 Fax 603-669-0270

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Agency/Organization Name Date

______________________________________________________________________

Agency Address

______________________________________________________________________

City State Zip

______________________________________________________________________

Agency Contact Person Job title

_________________________ ______________________ __________________

Phone Number Fax Number e-mail

What type of agency/organization do you identify with? (i.e. School, Church, Community Center, Wellness Center, Housing Development, Food Pantry etc.)

__________________________________________________________________

Briefly describe your organization’s work and mission. (Include the types of services, programs, trainings, etc you offer to your clients)

__________________________________________________________________

Is your organization a current member agency of the New Hampshire Food Bank?

ÿ Yes ÿ No

Does your agency serve low-income or needy individuals? ÿ Yes ÿ No

How do you determine low-income eligibility?

_________________________________________________________________

What type of clients do you serve?

Ethnic background:__________________________________________________

Age of clients:______________________________________________________

Sex:______________________________________________________________

Economic Situation:_________________________________________________

Do they receive WIC, Food Stamps, Etc._________________________________

Other details:_______________________________________________________

6. How did you hear about the Operation Frontline program?

__________________________________________________________________

What type(s) of class are you interested in hosting?

ÿ Eating Right (adults) ÿ Kids Up Front (ages 8-12)

ÿ Side By Side (kids & parents) ÿ Eating Right for Teens (ages 13-17)

ÿ Eating Well (people living with HIV/AIDS)

ÿ Saving Smart, Spending Smart (financial literacy)

In what ways do you think that cooking and nutrition education would benefit your participants?

__________________________________________________________________

9. Does your agency have access to a working kitchen facility for cooking demonstrations and classroom activities large enough to accommodate 8–15 people?

ÿ Yes ÿ No (if no, this does not automatically disqualify you for classes)

Does your agency currently have a van (or other means of transportation) and valid insurance for transporting clients and participants to and from your site and/or to other locales? ÿ Yes ÿ No

Operation Frontline can provide agencies with flyer designs to assist with recruitment; however, it is the agency’s responsibility to recruit the class participants. What is your current method of recruiting participants for various programs?

ÿ Flyers ÿ Phone Calls ÿ Mailings ÿ Newsletter ÿ other______________

How would you rate participation levels for community service programs offered at your facility?

ÿ High (100% - 80%) ÿ Moderate (79% - 50%) ÿ Low (49% - 20%)

What months, days, and times are convenient for hosting an Operation Frontline class series at your facility? Please give your top three choices: (If very flexible please note!)

_____________________________________________________________________________

______________________________________________________________________________

Operation Frontline requires agencies to provide childcare for children of adult participants when necessary. Does your agency currently have this capability?

ÿ Yes ÿ No

15. Your commitment to hosting an Operation Frontline class series is important to the overall success of this program at your agency. Are you willing and able to be actively involved in recruiting participants, be present during classes and assist with class preparation and other class needs? ÿ Yes ÿ No

Thank you for your interest in the New Hampshire’s Operation Frontline program! After reviewing your application, we will contact you to discuss the possibility of hosting a class at your agency. We hope to work with you soon!

For further questions or information please call Becca Story at

603-669-9725 or e-mail at bstory@nhfoodbank.org

For Operation Frontline office use only!

Reviewed by:	Class Code:
Date reviewed:	Date Class Held:
Accepted:	Outcome:

__________________________________________________ ________________

Agency/Organization Name Date

ÿ Eating Right (adults) ÿ Kids Up Front (ages 8-12)

ÿ Side By Side (kids & parents) ÿ Eating Right for Teens (ages 13-17)

9. Does your agency have access to a working kitchen facility for cooking demonstrations and classroom activities large enough to accommodate 8–15 people?

For further questions or information please call Becca Story at

For Operation Frontline office use only!

Date reviewed:

__________________________________