New York Coalition for Healthy School Lunches
Coalition Application Form – for Organizations


Please fill out this form and click the "Submit" button at the bottom of the page. Then print out the page that is displayed after the form is submitted. Sign this printed page and fax it to 914-381-6176 or mail it to New York Coalition for Healthy School Lunches, P.O. Box 737, Mamaroneck, New York 10543. The fax number and address will be displayed on the printable page.

By signing this form, you agree to officially endorse the goals of the organization in accordance with our mission statement; Be listed as a Coalition Member on the Coalition's website, Coalition materials, and other places where appropriate; Retain independent identity but agree to support the organization in the achievement of mutual goals.


Name of Organization: 

 Type of Organization :
Education Health Community Religious Other (*)
(*)If "Other", please explain: 
Street or Post Office Box: 
City: 
State: 
Zipcode: 
Contact Person Name: 
Contact Person Title: 
Contact Information  (Include area codes with phone numbers)
Work Phone: 
Cell Phone: 
Fax: 
Email Address: 
 
Please briefly state why you are interested in becoming a part of the Coalition.  Please let us know how your background and skills could assist in the overall success of the coalition, if applicable, and how you can contribute to the coalition: