CCBP Application Form SY 23/24

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 can come from parents/guardians or trusted teachers/adults at your child’s school.

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. 312) 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).
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.

ASSURANCE OF CONFIDENTIALITY:   Authorized persons involved in the Cambria County Backpack Project are required to maintain confidentiality of all personal information of applicants at all times.  Applicant records will be used only for the purposes of participation in the CCBP and will not be released or shared with any persons not connected with the project. Security safeguards will be in place to protect against loss and unauthorized access, use, modification, or disclosure of personal information.   

Please complete a separate CCBP application for each child!

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Name School/Agency that your child attends:  *
Child's Name: *
Gender:  *
Grade: *
Teacher:  *
Age: *
Race/Ethnicity: *
Parent/ Guardian & Relationship to child- 1 *
Parent/ Guardian & Relationship to child- 2 
Is one or both parent/guardian a veteran?  *
Best Phone Number *
Household Income *
Address: *
Email: *
Number of adults in household:  *
Number of kids in household:  *
Did your child receive bags of food last year?  *
How will the weekend food help your family? *
Are you currently receiving SNAP (food stamps)? *
Would you like information about SNAP (food stamps)? *
Are you currently receiving WIC benefits?  *
Would you like information about WIC benefits?  *
Would you like information about the nearest food pantry near you?  *
Are you currently employed?  *
Would you like more information about job opportunities?  *
Would you like information about Highlands Health (Johnstown's Free Medical Clinic)? *
How else can we help your family? Please explain! 
Does your child have any food allergies? (if yes, what?)  *

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:

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