Kansas Soybeans as a Food APPLICATION FORM

One semester and teacher per form

2020-2021 _____Fall Semester _____Spring Semester

School: ___________________________________________________

Address: ___________________________________________________

City: ________________________ State: _______ ZIP: __________

Teacher’s name: ______________________________________________

E-mail address: ______________________________________________

Telephone: _________________________________________________ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____

Amount requested (can receive $2/student up to $400/semester): $ ________________

Teacher’s signature: ___________________________ Date: __________

Notes or special requests:

Please apply by September 30, 2020, for the fall and February 28, 2021, for the spring. We will be flexible with these deadlines due to COVID-19, but please apply before spending any funds. We have

a quick approval turnaround. Return to: Kansas Soybean Commission

1000 SW Red Oaks Place Topeka, KS 66615-1207

Fax – 785-271-1302 E-mail – info@kansassoybeans.org

FOR OFFICE USE ONLY

Amount approved: $ ______________________

FCS program coordinator:__________________________________ Date Received: ________

Approval Letter sent: ______________________ Entered in database: ____________