Weekly HDM Participant and Meal Count

Name of Person Reporting: *
First Name Last Name
Phone: * ( ) - -
Email: *
Area Agency Name: *
Name of Nutrition Provider: *
Week Period: *
Start Date   End Date
Total number of meals delivered to homes (both HDM participants and temporary participants): *
Total number of people receiving meals delivered to homes: *
If numbers are significantly higher or lower than last week, please explain: i.e. boxed meals delivered, produce boxes delivered, more people added to route.

Enter the characters shown above in the box below: