Fillable Parent Pick- Up Waiver - Application COVID-19 (Mississippi)

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Parent Pick- Up Waiver - Application COVID-19 (Mississippi)

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MDE Office of Child Nutrition Revised 4/10/2020
Application to Participate in Waiver to Allow Parents and Guardians to Pick
Up Meals for Children During Unanticipated School Closures
SPONSOR: _________________________________________________________________
Waiver Request Applies to: ALL SITES SELECTED SITES (list below)
List of Sites:
Provide a description of the Parent/Guardian Meal Pick-Up System and how it will ensure that:
1) Meals are only distributed to parents or guardians of eligible children
2) Duplicate meals are not distributed to any child
MDE Office of Child Nutrition Revised 4/10/2020
By checking I acknowledge that information regarding the implementation of this waiver
must be reported to the State Agency after the emergency feeding program ends. A template
will be provided by the Office of Child Nutrition
_______________________________________________
Name of Authorized Sponsor Representative Submitting Form
_______________________________________________
Title of Authorized Sponsor Representative Submitting Form
___________________________
Date Submitted
STATE AGENCY USE ONLY
_________________________________________________
Approved by
___________________________
Date Approved:
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Parent Pick- Up Waiver - Application COVID-19 (Mississippi)

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Completed 16 July 2020

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