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Power Snack Sign Up Form

All fields marked with * are required.

Contact Information

Your First Name *

Your Last Name *

Your Title *

Your Email *

Your Phone Number *

School Name *

School Street Address *

School City *

School State *

School ZIP *

School County *

Total Number of Students in Your School *

Number of At-Risk Students *

How Do You Identify Hungry Students?

Please Share How the Power Snack Program Helps Relieve Hunger In Your School