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P-EBT Mini-Grant Application

This round of applications will close on Friday, July 30, 2021 by 11:59 p.m.

Please submit only one application per sponsor.

Required to obtain benefit. Form #NU-150. EDAC approved 5/7/21 for 2021-2022.


For internal use only. Applicants, please skip these fields.

Sponsor Information
Please select your sponsor name/code in order to complete the rest of the application.
Application Contact Information
Food Service Director Contact Information
If different from the application contact.
Reporting Periods
Please insert the start date associated with the costs incurred/requested for reimbursement (i.e., costs requested for reimbursement incurred starting 10/1/2020 for reporting 10/1/2020-3/30/2021).
Please insert the end date associated with the costs incurred/requested for reimbursement (i.e., costs requested for reimbursement incurred ending 4/30/2021 for reporting 10/1/2020-3/30/2021).
Budget Categories and Totals

Please provide totals for each applicable category as well as the total amount requested for reimbursement.

At the end of this application, you will also need to attach a detailed electronic budget showing the allowable costs by category.

$
$
$
$
$
$
$
Add the total cost for all budget categories and include that amount here.
Detailed Budget

A detailed electronic budget form (XLSX) must be submitted as part of your complete application. Applicants approved for funding will be asked to work with CDE to finalize the budget/expenditure requests prior to reimbursement.

How to submit your budget:

  1. Download Electronic Budget Form
  2. Click Choose File to select the file you want to upload - Excel format please.
  3. Click Upload to attach the file to your application.

Files must be less than 2 MB.
Allowed file types: xls xlsx ods xml.
Assurances
By checking the box, I certify that the information on the application in the Pandemic Electronic Benefit Transfer (P-EBT) is true and correct and that I will immediately report to the state any changes that occur to the information submitted. I understand that this information is being given in connection with reimbursement of federal funds. The state may verify information, and the deliberate misrepresentation of information will subject me to prosecution under applicable federal and state criminal statutes. I hereby certify that this School Food Authority will utilize the P-EBT reimbursement in accordance to the FY 2021 P-EBT Local Level Administrative Cost Grand Award.