REQUIRED FORM

SFSP 			 MEAL COUNT RECORD FOR MONTH OF ________________________________________
(For Open Sites)
    Sponsor Name_____________________________________Site Name_________________________________Site Supervisor_____________________________________________

Day of Month | BREAKFAST | LUNCH | SNACK

Eligible First Meals Served

Eligible
Seconds
Served

Non-Program Adult Meals
Served

Total Adult Meals Served

Eligible
First Meals
Served

Eligible 
Seconds
Served

Non-Program
Adult Meals
Served

Total Adults
Meals Served

Eligible
First Meals
Served

Eligible Seconds Served

Non-Program Adults Meals Served

Total Adult Meals Served

1 | | | | | | | | | | | |
2 | | | | | | | | | | | |
3 | | | | | | | | | | | |
4 | | | | | | | | | | | |
5 | | | | | | | | | | | |
6 | | | | | | | | | | | |
7 | | | | | | | | | | | |
8 | | | | | | | | | | | |
9 | | | | | | | | | | | |
10 | | | | | | | | | | | |
11 | | | | | | | | | | | |
12 | | | | | | | | | | | |
13 | | | | | | | | | | | |
14 | | | | | | | | | | | |
15 | | | | | | | | | | | |
16 | | | | | | | | | | | |
17 | | | | | | | | | | | |
18 | | | | | | | | | | | |
19 | | | | | | | | | | | |
20 | | | | | | | | | | | |
21 | | | | | | | | | | | |
22 | | | | | | | | | | | |
23 | | | | | | | | | | | |
24 | | | | | | | | | | | |
25 | | | | | | | | | | | |
26 | | | | | | | | | | | |
27 | | | | | | | | | | | |
28 | | | | | | | | | | | |
29 | | | | | | | | | | | |
30 | | | | | | | | | | | |
31 | | | | | | | | | | | |

Total
Days
Served

Total Eligible First Meals

Total 
Second Meals

Total
Non-Program Adults

Total Adults

Total Eligible First Meals

Total 
Second
Meals

Total
Non-Program
Adults

Total
Adults

Total Eligible First Meals

Total
Second Meals

Total
Non-Program
Adults

Total Adults