Kansas Soybeans as a Food APPLICATION FORM One semester and teacher per form 2020-2021 _____Fall Semester _____Spring Semester School: ___________________________________________________ Address: ___________________________________________________ City: ________________________ State: _______ ZIP: __________ Teacher’s name: ______________________________________________ E-mail address: ______________________________________________ Telephone: _________________________________________________ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Name of class: ____________________ No. of students:_____ Grade level: ____ Amount requested (can receive $2/student up to $400/semester): $ ________________ Teacher’s signature: ___________________________ Date: __________ Notes or special requests: Please apply by September 30, 2020, for the fall and February 28, 2021, for the spring. We will be flexible with these deadlines due to COVID-19, but please apply before spending any funds. We have a quick approval turnaround. Return to: Kansas Soybean Commission 1000 SW Red Oaks Place Topeka, KS 66615-1207 Fax – 785-271-1302 E-mail – info@kansassoybeans.org FOR OFFICE USE ONLY Amount approved: $ ______________________ FCS program coordinator:__________________________________ Date Received: ________ Approval Letter sent: ______________________ Entered in database: ____________