Cooking Matters Satellite Partner Application Cooking Matters Satellite Partner Application Organization Name*Date* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Contact* First Last Job TitlePhone*Fax NumberEmail* Organizational Information1. How do you classify your organization?*(i.e Food Bank, School, Church, Community Center, Wellness Center, Housing Development, Food Pantry etc.)2. Briefly describe your organization’s work and mission. (Include the types of services and programs you offer to your clients)*3. Does your agency serve low-income individuals?*YesNoDo your clients receive WIC, Food Stamps or other nutrition assistance?*YesNoIf yes, what percentage of those served participate in nutrition assistance programs?3a. How do you determine low-income eligibility?*4. How would you rate participation levels among eligible clients for community service programs offered by your organization?*High (100% - 80 %)Moderate (79% - 50 %)Low (49% - 20%)Facility Information5. Do you plan to host Cooking Matters classes at your own facility?*YesNo5a. Does your organization have access to a working kitchen facility for cooking classes?*YesNoIf not, does the facility offer access to a sink, for hand/ dish washing?YesNo5b. Does your organization have:* A classroom area large enough to accommodate 8–15 people? Easy accessibility for clients who rely on public transportation? Cooking Matters Assessment6. How did you hear about Share Our Strength’s Cooking Matters program?*7. Have you observed a Cooking Matters class?*YesNoIf yes, list Course Names and LocationsCourse NameLocation 8. Why are you interested in bringing Cooking Matters courses to your clients and/or community? How does Cooking Matters differ from and/or complement other related programs currently offered in your community?*9. Which Cooking Matters curricula are you interested in offering in your community?* Cooking Matters for Adults Cooking Matters for Kids (grades 3-5) Cooking Matters for Teens (grades 6-12) Cooking Matters for Families (one child, age 6 and older & their parent/caretaker) Cooking Matters for Young Parents (pregnant/parenting teens) Cooking Matters EXTRA for Parents of Preschoolers Cooking Matters EXTRA for Diabetes Cooking Matters EXTRA for Wellness Parents of Preschoolers Families (parent and child together) Child Care Professionals Families (Spanish) Kids 10. Please describe your short and long-term goals for a Cooking Matters program.*External Resource AssessmentCooking Matters courses are generally held at a host agency site that already reaches Cooking Matters’ target population and has the ability to recruit appropriate course participants. Courses are taught by volunteer chef instructors, nutritionists and financial planners.11. Please list any local agencies/organizations in your area, besides your own, that could serve as host sites for Cooking Matters courses.Agency/OrganizationRelationship Note any existing relationships with these organizations.12. Please list any other existing relationships/arrangements that could help support your class implementation.Agency/OrganizationRelationship (e.g., relationships that could result in in-kind donations of food or other class materials, volunteers, etc).13. Do you have the ability to recruit, train and support culinary and nutrition volunteers who will teach Cooking Matters courses? What methods will you use to recruit them?*14. Do you have a clear understanding of the roles and responsibilities expected of a Cooking Matters Satellite Partner? Please comment on your organization’s ability to fulfill those roles.*15. Is there a dedicated staff person who will coordinate your Cooking Matters courses?*YesNo15 b. If so, please describe the potential coordinator’s qualifications? What percent of their time would be dedicated to Cooking Matters? Would their time require special funding? If so, where will the funding come from? If not, do you have the funds (and management support) to hire staff to fill this role?16. Do you have executive level/management support to run a Cooking Matters program?*YesNo16b. If so, please submit a signed letter of support from your organization’s leadership with this application (please include current contact information).Accepted file types: pdf, doc, docx.Upload a Word or PDF document.Funding Assessment17. What funding does your organization currently have available/allocated for running a Cooking Matters program? Where does the funding come from? How long will it last?*18. Will your organization seek additional funding for running a Cooking Matters program?YesNo18b. If so, how long will it take to get the funding, and where will you seek it?19. Is your organization prepared to cover the cost of course equipment (e.g., bins – approx $500 per bin set)?*YesNo19b. If so, how will it be funded?20. Is your organization prepared to cover the cost of/supply in-class and take-home groceries, as well as in-class supplies (e.g., eating utensils, plates/cups) for all Cooking Matters courses and class participants?*YesNo20b. If so, where will the funding come from? Is it sustainable?21. Is your organization prepared to cover the cost of any necessary child care for Cooking Matters course participants’ children?*YesNo22. Is your organization prepared to cover the cost of any necessary translation services for non-English speaking Cooking Matters course participants?*YesNo23. Does your organization have the ability/willingness to help raise additional funds, as necessary, to support the costs of running Cooking Matters courses in your community?*YesNoThank you for your interest in Share Our Strength’s Cooking Matters program! After reviewing your application, we will contact you to discuss the possibility of partnering with your organization to offer Cooking Matters courses on a satellite basis. CommentsThis field is for validation purposes and should be left unchanged.