School Market Program Report

Please submit by the 5th of each month.

This form is for the month of:

School Name

Your Name:

E-mail Address:

Total number of students served (unduplicated):

Total number of pantry visits (including return visits):

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Total number of household members served (Use N/A if not tracked):

Total number of household members served under 18 (Use N/A if not tracked):

Has your contact person changed?

Please list new contact person here:

Please share your comments: