Form FNS-781 Team Nutrition School Enrollment Form

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

Team Nutrition School
Enrollment Form

Our Team Nutrition School Leader is:
FIRST NAME

LAST NAME

TITLE

SCHOOL'S NAME

TOTAL ENROLLMENT

GRADES TAUGHT

SCHOOL DISTRICT

SCHOOL COUNTY

SCHOOL ADDRESS

STATE

CITY
TELEPHONE

(

FAX

)

ZIP CODE

(

)

E-MAIL ADDRESS
Please check one or more of the appropriate grade ranges:
P (PRESCHOOL) PRE-K

E (ELEMENTARY) K-5/6

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.

M (MIDDLE) 6/7-8

H (HIGH) 9-12

• 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, PRINTED NAME

SCHOOL FOOD SERVICE MANAGER, PRINTED NAME

SIGNATURE

SIGNATURE

DATE

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.
Form FNS-781 (12-08) Previous Editions are Obsolete

SBU

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