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Team Nutrition School Enrollment Form

(Need to have your school deleted? Email Team Nutrition at teamnutrition@fns.usda.gov with the school name and address.)

Please complete a form for each individual school, not one for a district.

Enrollment type - Please state if this is: *

A new enrollment

An information update

Our school participates in the National School Lunch Program (required to join Team Nutrition) *

Our Team Nutrition School Leader is:

First Name: *

Last Name: *

Title: *

E-Mail Address: *

Confirm E-Mail Address: *

School Information:

Name: *

Please spell out the school's full name, using no abbreviations.

Total Enrollment:

Grades Taught: *

District: *

County: *

Please check one of more of the appropriate grade ranges: *

Preschool (Pre-K)

Elementary (K-5/6)

Middle (6/7-8)

High (9-12)

Address 1: *

Address 2:

City *

State *

Zip: *

Phone: *

Fax:

We agree to:

Support USDA's Team Nutrition goal and values.
Demonstrate a commitment to help students meet the Dietary Guidelines for Americans.
Designate a Team Nutrition School Leader who will establish a school team.
Distribute Team Nutrition materials to teachers, students and parents.
Involve teachers, students, parents, foodservice personnel, and the community in interactive and entertaining nutrition education activities.
Participate in the National School Lunch Program.
Demonstrate a well-run Child Nutrition Program.
Share successful strategies and programs with other schools.

We certify our school does not have any outstanding overclaims or significant program violations in our school meals programs.

School Principal: *

Principal's Email: *

Date: *

School Food Service Manager: *

School Food Service Manager's Email: *

Date: *

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-0524). Do not return the completed form to this address.

OMB Control No.: 0584-0524
Expiration Date: 04/30/2013

Last Modified:

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