Health and Wellness Site Activity Application
If this is your first time requesting a program, please answer all questions. If you have requested a program in the past, you only need to answer the questions marked with the red asterisk.
*Please note: Due to COVID-19, we are not scheduling in-person events prior to 9/7/2020. Virtual programming is available for several programs.*
Name of Organization *
Organization Website
Street Address
City
County
State
Zip Code
Primary Contact Person *
Job Title
Phone Number *
Fax Number
E-Mail *
1. Is your organization a member of the Food Bank of South Jersey (FBSJ)?
Clear selection
2. Has your organization partnered with the FBSJ in the past?
Clear selection
3. How did you hear about the FBSJ Health and Wellness Department?
Clear selection
4. How do you classify your organization?
5. Does your organization serve low-income individuals?
Clear selection
6. Do your clients receive food or nutrition assistance (WIC, SNAP/Food Stamps, Senior Farmer's Market, CSFP, etc.)?
Clear selection
7. How would you rate participation levels among clients for workshops offered by your organization?
Clear selection
8. Briefly describe your organization's work and mission.
Include the types of services and programs you offer to your clients.
9. Please select the first activity that you are interested in hosting at your organization. When grant funding is available to cover the fees, activities are offered at no cost. *
Please select only one activity. This form allows you to apply for one activity and an alternate activity. When grant funding is available to cover the fees, activities are offered at no cost. If you would like the Food Bank of South Jersey to host an information table at your event, contact Volunteer Services at volunteers@foodbanksj.org , or call (856) 662-4884.
10. How would you like this activity to be delivered? *
11. Please indicate the date and time you would like to begin the first activity. *
We request at least 2-4 weeks of lead time to schedule all activities. Activities can be scheduled Tuesday - Saturday.
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12. Please provide an alternate date and time to begin. *
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13. Who do you expect to participate in the activity? Check all that apply. *
Required
14. How many individuals do you expect to participate? *
15. Is there anything else you would like us to know about the participants?
16. Please select an alternate activity. We will attempt to schedule this second activity if we are unable to schedule the first. When grant funding is available to cover the fees, activities are offered at no cost.
Please select only one activity. This form allows you to apply for one activity and an alternate activity. When grant funding is available to cover the fees, activities are offered at no cost.
Clear selection
17. How would you like this activity to be delivered?
Clear selection
18. Please indicate the date and time you would like to begin the second activity.
We request at least 4-6 weeks of lead time to schedule all activities.
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19. Please provide an alternate date and time to begin.
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Time
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20. Who do you expect to participate in the activity? Check all that apply.
21. How many individuals do you expect to participate?
22. Is there anything else you would like us to know about the participants?
23. Please indicate in which county the activity will be held. Do not use the address of your main office unless it is the class location. *
24. Please describe the space where you would like to hold the activity. Check all that apply. *
Required
25. How do you plan to fund the requested programming? Purchase orders (P.O.s) are accepted. *
26. Is your organization funded through any of the following sources? *
Required
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