Form

H.A.P.P.Y. School Online Application

District Name:

District community outreach contact name:

District community outreach email address:

District community outreach contact phone number:

Campus Name:

Campus Address:

Campus Counselor Name:

Campus Counselor Email Address:

Campus Counselor Phone Number:

Title 1 School:

Most recent data of percentage of economically disadvantaged population at campus:

Most recent data of number of students on free and reduced lunch at campus:

Estimated number of monthly bags requested:

Estimated number of monthly snacks requested:

Does this campus have current or future partnerships with other backpack programs? Please list outside support and monthly bags provided:

Please attach any supporting documentation here:

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