Today's Date *

MM

DD

YYYY

Which 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 Matter at Home Series

Cooking Matters for Families (adults and kids age 8-12)

Cooking Matters for Kids (ages 8-12)

Cooking Matters for Teens (ages 13-18)

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?

This can be offered as a one-time event or a 7- week series of one-time events. Select all that apply

Kids Say Yes To Fruits & Veggies (parent audience))

Making Recipes Work For You

No More Mealtime Madness

Hack Your Snack

The Family Kitchen (parent audience)

Drink To Your Health

Feeding in the First Year (parent audience)

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

19. Do you plan to host Cooking Matters programming at your facility? *

Yes

No

20. Does your organization own or have access to a working kitchen for Cooking Matters classes? *

Yes

No

21. Is there a sink with running water that a Cooking Matters coordinator will have access to? *

Yes

No

22. Is there a space large enough to accommodate 10 – 15 participants? *

Yes

No

23. Is your facility easily accessible for participants who rely on public transportation? *

Yes

No

24. 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

25. Are you willing to allow individuals from outside of your organization to register for a class at your location? *

Yes

No