New Look of Milk Grant Application

Offer Valid only in Ohio and West Virginia
Complete and submit this form to apply for the

Grant

>>>Please Print for Your Records<<<

Submission of this form indicates agreement to the grant term

Please check one circle and fill in the date

Yes!! We serve milk in 8 oz. plastic. We retired the carton on (MM/YY)
Yes!! We plan to retire the milk carton on (MM/YY)

Participating District Information

School District
County
Contact First Name
Contact Last Name
Title
Email
District Contact Address
City	State Zip
Phone	Ext.
Fax
District Enrollment
Number of District Elementary Buildings
Number of District Middle Buildings	(Include all K-12 here)
Number of District High Buildings
Number of 'Other ' Buildings	(JVS,Ed Ctr, PreK, ect.)
Milk Processor

Submission of this form indicates agreement to the grant terms

>>>Please Print for Your Records<<<