SY 22-23 Application Form

Dear Parents or Guardians,

The Cambria County Backpack Project (CCBP) is available to children in need of weekend food assistance at no cost to participants. Funded entirely from grants and donations, the CCBP aims to provide weekend meals to children who have limited access to healthy foods when they are not at school. Referrals typically come from trusted teachers/adults at your child’s school or participating organization. In light of hybrid learning environments in 2022-23, parents/guardians may also self-refer.

When you complete and return this application, your child will receive six ready-to-eat meals each week. Continued participation is based on ongoing need. We ask that you inform the school/agency if there comes a time when you do not need or want CCBP support. We have a limited number of backpacks each week and need to serve those children who have the greatest need.

If you have questions, please contact the CCBP coordinator at ccbpcoordinator@thelearninglamp.org (814-262-0732 ext. 311) or the CCBP representative of the agency/school that your child attends.

Please be advised that all recipients of the Cambria County Backpack Project are expected to act in accordance with the following behavior policy, in order to be eligible to participate in CCBP: 

·All recipients are expected to transport their weekly bag of food home INSIDE of a backpack, gym bag, or duffel bag.

·All recipients are expected NOT to open their bag of food until they are at home. Bags are NOT to be opened on a bus or on the way home from school.

·All recipients are expected NOT to share the contents of their bag with friends or other students. The food is strictly for your child(ren).

It is the Cambria County Backpack Project’s mission to help reduce childhood hunger in Cambria County, and by following the above guidelines, we can ensure that your child is safely receiving all of the food to which he/she is entitled as an approved backpack participant.

Please be aware that if your child is found eating food on the school bus, giving food away, or in any way using the food or packaging in an inappropriate or harmful manner, your child is subject to disciplinary action from his/her school or referral agency, as well as removal from the Cambria County Backpack Project.


SIGNATURE / CERTIFICATION:  I have read the assurance of confidentiality statement, food allergy disclaimer, and the application and behavior contract and authorize my child to participate in the Cambria County Backpack Project.

Parent/Guardian Name: ___________________________________________________       Date: ______________

Google にログインすると作業内容を保存できます。詳細
Name of School
選択を解除
Child's Name
Gender
選択を解除
Grade
選択を解除
Name of child's teacher
Age
Ethnicity
選択を解除
Race
選択を解除
Child Lives With (check all that apply)
Parent/Guardian-1 Name & Relationship to child:
Veteran Status
選択を解除
Parent/Guardian-2 Name & Relationship to child:
Veteran Status
選択を解除
Best Phone Number
Are you able to receive text messages?
選択を解除
Email
Address
Did your child receive bags of food last year?
選択を解除
Please provide a brief explanation as to how the weekend food will help your family. 
Need for Services? (check all that apply)
Number of people in household (adults and children)
Every time you participate in CCBP you earn chances to win a gift card. Some examples of participating are following and interacting with our Facebook page (Cambria County Backpack Project), signing up for our Remind app (https://www.remind.com/join/bcoordin), subscribing to our newsletter (https://www.ccbackpack.org/), and checking your child's bags for recipes and nutritional information. Would you like a chance to win a $500 gift card?
選択を解除
次へ
フォームをクリア
Google フォームでパスワードを送信しないでください。
このコンテンツは Google が作成または承認したものではありません。 不正行為の報告 - 利用規約 - プライバシー ポリシー