NEW SCHOOL ENQUIRY

The Y Schools' Breakfast Program

School Assistance Enquiry Form
Please complete ALL questions before you submit your enquiry. If Not applicable please enter NA
Q1. What region / area is your school located?*

BeaudesertBrisbane (Eastern Suburbs)Brisbane (North)Brisbane (South)Brisbane (South/West)Central QueenslandGold CoastIpswichLoganMoreton BayRedlandsSunshine CoastTownsvilleWide BayOutside of these areas however can collect supplies from one of these areas.Outside of these areas and too far away to collect supplies from Logan City.Other
Q2. Name of School*
Q3. Suburb where your School is located*
Q4. Does this request have support of the Principal*
Please answer the following questions about your school's breakfast program (or proposed program):
Q5. Are you seeking support for a 'new' or 'existing' breakfast program?*

New Breakfast ProgramExisting ProgramOther
Q6. How many mornings a week would your school like to run a breakfast program?*
Please Note: Schools who can only run a breakfast program once or twice a week (i.e. less than 3 days) may not be eligible for direct deliveries* or loan of large equipment). *At this stage the YMCA is only able to deliver supplies directly to schools located in Logan, Ipswich, Brisbane, Moreton Bay Regions. We are planning for Redland Bay region
Q7. If your school can only run its breakfast program one or two mornings a week, will your school be able to collect food supplies from Logan or a neighbouring school (if avail as an option)?*

NA -we can run our program 3 or more days a weekWe can collect supplies from Logan CityWe can collect from another school if avail as an optionNo, we are unable to collect from anywhereOther
Q8. Estimated number of students who will attend your breakfast program per day? *
Q9. How long will the breakfast program run for each morning:*

20 minutes max25 minutes max30 minutes max30+ minutesOther
Q10. Where will your school run their Schools' Breakfast Program - example at within or near Tuckshop, hall kitchen, staff lunch room, special education unit, class room, hall, undercover area etc. Please explain your best option. *
Q.11 What access and visibility will the breakfast program have (select all that apply):*

A busy well known area where lots of students goA quite area where not many students goA closed off area where students will need to seek permission to enterA small area where student numbers will need to be limitedOther
Q12. Who will the breakfast program be open to:*

Any student within the whole school who wishes to participatePrep students onlyPrep and Junior students only (in a P-12 school)Special Education students onlyOnly students teachers identify as hungryOther
Q13. How long does your school intend to run a breakfast program?*

One term only (as a trial)Two or three terms (as a trial)Long term / ongoingOther
How should we contact you?*

PhoneEmailOther
Q14. Does your school currently receive any 'donations of food' for its Breakfast program? If so, please list the type of food below and who donates them (N.B. This will not disqualify you from receiving for support from the Y).*
Q15. Does your school receive any Funding $ specifically for its Breakfast Program? If so, please enter below the $ amount received each year (enter NA or 0 if zero). N.B. This will not disqualify you from applying for support from the Y. *
Q16. Please provide information that demonstrates the School's need for a Breakfast Program. The YMCA Schools' Breakfast Program does use the ICSEA values however we understand there are other reasons a school requires support. Please provide a short outline on why your school would like to have our program to support your children and familes. *
Q17. Do you have a team of volunteers or teachers to assist you with running the breakfast program? (Ideas to consider are local community groups, head of grade or subject, Social Science, faculty, staff, families, student leaders, house captains, prefects, etc. )*

Yes, I have a team ready to helpNot yet, but I am close to having a full teamNo, but I can run it on my ownOther
Comments
Your Full Name*
Your position or role*
Your Email
Your Email:*
example@example.com
Your Phone Number*
Q18. How did you hear about the YMCA Schools' Breakfast Program?*

Google searchWord of mouthI (or someone in my school) used to work in a school with a Breakfast Program supported by the YMCAThrough Scripture UnionOther
Privacy Statement

YMCA is gathering the information on this form to be able communicate with you and make necessary arrangements for the activities of the YMCA School's Breakfast Program. If you do not provide this information, then we may be unable to offer this program to your school. The information will be stored securely in YMCA systems located with Australia. The YMCA will not share your information without your express permission unless required to under law or to comply with court process. Should you wish to access to update your contact details or communication preferences, please contact us at breakfast@ymcaqueensland.org.au
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The Y Schools' Breakfast Program