Weekly Participant Count by Congregate Site

Name of Person Reporting: *
First Name Last Name
Phone: * ( ) - -
Email: *
Area Agency Name: *
Name of Nutrition Provider: *
Site Name: *
Week Period: *
Start Date   End Date
Number of Days Open: *
Total Number of Participants for the Week: *
Number of Meals Served/Distributed this Week: *
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: