Fillable Area Eligibility Waiver Request To Participate Ver040720 Covid (Mississippi)

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Area Eligibility Waiver Request To Participate Ver040720 Covid (Mississippi)

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Application to Participate in Area Eligibility Waiver SFSP during
Unanticipated School Closures
Sponsor: ___________________________________________________
Sites with 40-49% free/reduced eligibility:
For each site list the following:
Site name
Area eligibility percentage
Plan for how known free/reduced children in the school zone would be targeted (e.g. bus
route, e-mail blast to f/r eligible families)
Sites with less than 40% free/reduced eligibility:
For each site list the following:
Site name
Area eligibility percentage
Plan for how known free/reduced children in the school zone would be targeted (e.g. bus
route, e-mail blast to f/r eligible families)
Specific justification for the need to operate the site (e.g. pocket of poverty, local knowledge of
COVID 19-related unemployment that would likely make many families newly eligible for free
or reduced benefits)
By checking I acknowledge that this information must be reported in narrative form to the State
Agency after the emergency feeding program ends. A template will be provided by the SA
A summary of the use of this waiver by the State agency and local Program operators:
• A summary of how new meal sites were targeted to benefits for children who were previously
eligible or newly eligibly for program benefits due to the economic impacts of COVID-19, and
• A description of whether and how this waiver resulted in improved services to Program
participants.
_______________________________________________
Name of person submitting
_______________________________________________
Title of person submitting
___________________________
Date Submitted
STATE AGENCY USE ONLY
Approved by _________________________________________________
Date Approved: ______________________
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Area Eligibility Waiver Request To Participate Ver040720 Covid (Mississippi)

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Completed 16 July 2020

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