OHIO STATE UNIVERSITY EXTENSION Document Title Sub head 1 OSUE SNAP-Ed Adult & Parent Curricula HOST SITE INFORMATION SHEET / CHECKLIST Host Site / Organization Information:______________________________ Host Site/Organization NameStreet Address ___________________________________________________________________ CityCountyStateZip ___________________________________________________________________ Host Site Contact Person: Name & Phone Number ___________________________________________________________________ Day of Class: Host Site Point Person: Name & Phone Number Dates of series: _____________________________________________________ How would you classify the organization? Please check: Food Pantry Church/Faith Based Community Center Health Clinic/Center Wellness Center Housing Development Other: ________________________________________________________ Describe the Space: (E.g. employee kitchen) ____________________________ Please confirm the agency serves SNAP eligible participants: Confirmed

OHIO STATE UNIVERSITY EXTENSION Document Title Sub head 1 OSUE SNAP-Ed Adult & Parent Curricula Checklist: Minimum Requirements for Host Site class space Please confirm/check: Refrigeration for perishable groceries Hot Running Water Sink large enough to wash dishes Working electrical outlets Work space sizable enough for all participants to prepare recipes Enough tables and chairs to accommodate entire group The space is far enough away for potential distracting activities (e.g. exercise class) Host site has identified a committed site contact/point person for day of & during classes. Point person helps with set-up of class and greeting participants. Point person has an understanding of the course and the participants. ** A heat source is not a requirement for the space, but it is however a requirement for the course. Resource Sharing: Will host site be providing resources? Resource sharing is encouraged, not required. Yes No Please Check & provide description of resources host site to provide: All Kitchen Equipment (bowls, plates, utensils, cooking equipment, pots/pans) Some Equipment. Describe:_______________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________

OHIO STATE UNIVERSITY EXTENSION Document Title Sub head 1 OSUE SNAP-Ed Adult & Parent Curricula Resource Sharing: Please check resource to be provided by host site Food: (In-Class Ingredients for Recipes / Take-Home Groceries.) Describe: _________________________________________________ Shopper Class Assistant Culinary Volunteer Instructor Volunteer to assist. Describe: ____________________________________ _______________________________________________________________ Childcare Transportation Participants Was a grant secured to host OSUE SNAP-Ed Cooking Matters series at this site: No Yes, Describe:_________________________________________ Is site providing funding? No Yes. Describe:_______________________ Site to provide other resources: Describe:___________________________