EmailMe Form - Cooking Matters Host Site Application

Organization Name

Date Time

MM / DD / YYYY

Which of our service areas do you operate in? If you operate outside of our service areas (i.e. Fremont, Antioch, etc.), we will not be able to host classes at your site.

Alameda County (Berkeley-Hayward)

Contra Costa County (Richmond-Concord)

San Francisco County

None of these

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary Contact Person

Job Title

Phone

### - ### - ####

Fax

### - ### - ####

Email

Organizational Information

1. How do you classify your organization? (i.e. 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?

Yes

No

3. Does your agency serve parents of young children (ages 0-5)?

Yes

No

Do your clients receive WIC, Food Stamps or other nutrition assistance?

Yes

No

If yes, what % of those served participate in nutrition assistance programs?

How do you determine low-income eligibility? Can you provide us with this verification?

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%)

5. Do you plan to host Cooking Matters classes at your own facility?

Yes

No

If Yes:

a. Does your organization own or have access to a working kitchen facility for cooking classes?

Yes

No

(If not, does the facility offer access to a sink, for hand/ dish washing?)

Yes

No

b. Does your organization have access to a classroom area large enough to accommodate 8–15 people?

Yes

No

c. Is your facility easily accessible for clients who rely on public transportation?

Yes

No

Cooking Matters

6. How did you hear about Share Our Strength’s Cooking Matters program?

7. Have you observed a Cooking Matters class?

Yes

No

If so, please provide the following information:

Course Name:

Class Location (e.g.: agency/organization name):

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 courses are you interested in offering in your community?

External Resource Assessment:

Cooking Matters courses are generally held at a host agency site that already reaches CM’s target population and has the ability to recruit appropriate course participants. Courses are taught by volunteer chef instructors, nutritionists, and class assistants.

10. Please list any other existing relationships or arrangements that could help support your class implementation (e.g., relationships that could result in in-kind donations of food or other class materials, volunteers, funding, etc).

11. Please list two other local organizations that serve low-income families that you think could benefit from Cooking Matters program. Include the name of the organization and, if you have it, contact info.

Thank you for your interest in Cooking Matters! After reviewing your application, we will contact you to discuss the possibility of partnering with your organization to offer Cooking Matters courses.