Consumer Research for Nutrition Educatoin and Promotion Activities (SLT)

TN School Enrollment Form | Food and Nutrition Service

TN School Enrollment Form
OMB Control No.: 0584-0524
Expiration Date: XX/XX/XXXX
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid
OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 5 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.

School Name *

School Address Line1 *

School Address Line2

School Address Line3

School City *

School District *

School County *

School State *

School Region



- Select -

School Postal Code *

School Fax

School Phone *

Total Enrollment

Grade Level

Pre-K

KG

School Type

Elementary

1

2

3

Middle

4
High

School Principal *

5

6

7

Charter

8

9

RCCI

10
None

11

12
Other...

TN Leader First Name *

TN Leader Last Name *

Food Service Manager Name *

TN Leader Email *

Food Service Manager Email

TN Leader Phone Number

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Last Published: 01/07/2016

http://www.fns.usda.gov/webform/tn-school-enrollment-form

5/17/2016