Form FNS-781 Team Nutrition School Enrollment Form

TN School Enrollment Form | Food and Nutrition Service

TN School Enrollment Form
OMB Control No.: 0584-0524
Expiration Date: XX/XX/XXXX
This information collection is being collected to assist the Food and Nutrition Service (FNS) in providing the public with information concerning its child nutrition programs. This voluntary information will be used to
develop nutrition education resources and interventions for population groups served by FNS. Under the Privacy Act of 1974, any personally identifying information obtained will be kept private to the extend provided
by law. 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. 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 Service, Office of Policy Support, 3101 Park Center Drive, Room 1014,
Alexandria, VA 22302 ATTN: PRA (0584-0524). Do not return the completed form to this address.

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