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Elder Nutrition Program Partnership survey

  1. Elderly Nutrition Program provider application

    Business interested in providing Elderly Nutrition Program services for Bayfield County residents should complete and submit this survey. Make sure to answer all questions/provide all requested documents. When completed, please press the Submit button, or if you prefer, print it out and mail to BCDHS, Attn: ENP partnership application, PO Box 100, Washburn, WI 54891.

  2. 1. What is the name and address of your business?

  3. 2. Contact information of the owner/manager:

  4. 4. Have you had any health code violations in the last 3 years?

  5. 6a. Do you currently have the staff capacity to prepare meals for this program?

  6. 7. Do you have the capacity to provide take-out meals from your location for this program?

  7. 8. Do you have the capacity to deliver meals from your location?

  8. 9. Do you have an invoicing system that can break down raw food costs?

  9. dietary criteria 2020

  10. Leave This Blank:

  11. This field is not part of the form submission.