Supply Mobile Application
After this form is submitted, a BTSS representative will contact you within three days.
Email address *
School/Program Name *
Your answer
School/Program Address *
Your answer
School/Program Phone Number *
Your answer
Coordinator Name (person setting up the visit) *
Your answer
Coordinator Phone Number *
Your answer
Type? *
Title I? *
Percentage of students who are FARMS (Free And Reduced Meals Students), if known *
Your answer
Number of students at the school/program *
Your answer
Number of instructional staff at the school/program *
Your answer
Preferred time period *
Preferred day *
Are there any dates over the next month you PREFER for delivery or DO NOT want delivery scheduled?
Your answer
Provide the name of a person from the school/program who will assist with setting up, distribution, and packing up *
Your answer
Provide a safe location that is 30 feet long to park legally for 3 hours. Where can the mobile park? *
Your answer
If your school is approved for distribution, you will be responsible for providing a small table and two chairs, communicating with staff about the mobile, and reserving a safe parking space. We expect a minimum of ten staff members who will visit the truck. If fewer than ten staff members visit the Supply Mobile, you may lose the privilege of future visits. BTSS reserves the right to cancel your visit if the above terms are not met. Do you agree to these terms? *
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