Today's Date *

MM

DD

YYYY

Which virtual Cooking Matters opportunity are you applying for? *

Cooking Matters Six‐Week Course Series

Cooking Matters at the Store (CMATS) Tour

Cooking Matters at Home

Physical Address *

Cooking Matters programming available through Gleaners Community Food Bank in Wayne, Oakland, Macomb, Livingston, and Monroe counties only

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

3. Are there currently other nutrition education programs being offered at your site? *

Yes

No

4. Is your agency/organization currently a member agency of Gleaners Community Food Bank? *

Yes

No

5. Does your organization serve low‐income individuals? *

Yes

No

6. Do your clients receive WIC, SNAP (formerly Food Stamps), or other nutrition assistance? *

Yes

No

8. How would you rate participant levels among eligible clients for community service programs offered by your organization? *

High (100 – 80%)

Moderate (79 – 50%)

Low (49 – 0%)

10. Have you observed a Cooking Matters class? *

Yes

No

12. If applying to host a Cooking Matters six week class series, which curriculum are you interested in providing?

Select all that apply

Cooking Matters for Adults

Cooking Matters for Child Care Professionals

Cooking Matters for Teens (ages 13 – 17)

Cooking Matters for Kids (ages 8 – 12)

Cooking Matters for Families (1 adult 1 child ages 8-12)

13. If applying to for a Cooking Matters at the Store (CMATS), which opportunity are you interested in providing?

Cooking Matters at the Store (CMATS) for Adults Tour

Cooking Matters at the Store (CMATS) for Adultos

Cooking Matters at the Store (CMATS) for WIC

Cooking Matters at the Store (CMATS) for WIC (Spanish)

14. If applying to host a Cooking Matters at Home (one time event) which opportunity(s) are you interested in providing?

These class options can be offered as a one-time event or a mini-series up to 7 week series of one-time events. Select all that apply.

Kids Say Yes to Fruits & Veggies (parents only)

Making Recipes Work For You

No More Mealtime Madness

Hack Your Snack

The Family Kitchen (parents only)

Money-Saver Alert

Drink To Your Health

Feeding in the First Year (parents only)

15. Does your site offer translation services for non‐English speaking classes? *

Yes

No

16. Which days of the week can you host a class? *

Select all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

18. Will a member of your staff be able to attend the entire Cooking Matters program? *

Required for Cooking Matters for Kids and Cooking Matters for Teens classes

Yes

No

19. Are you willing to allow individuals from outside of your organization to register for the online class? *

Yes

No