West Virginia Department of Education ~ Office of Child Nutrition
Summer Food Service Program
Electronic Website ~ Sponsor User Registration
Sponsor Name
Sponsor Address
(complete address)
Grant ID
Phone number
Fax Number
First Name
Last Name
3 Initials
Email
Phone
(if different from above)
1
2
3
4
5
6
7
8
9
10
The person(s) listed above have the authority to access the Summer Food Service Program
electronic claim and electronic application website. If any of this information changes, I will notify the
Office of Child Nutrition.
Signature of Authorized Representative
Date
Name of Authorized Representative
Title
Electronic User Registration