Instructions
Complete the following information and click Submit. In addition to this form, you will need to fax or email the following items to:
Naomi Velazquez Greene at 217/524-6124 or ngreene@isbe.net
:
  • Copy of the signed W-9 form
  • Documentation of tax-exempt/non-profit status
  • Program Announcement/Policy Statement
Your organization will then be assigned an Agreement Number and contacted regarding an ISBE Web-based Illinois Nutrition System (WINS) administrative account.
Sponsor
DUNS #: (9 digit number, NOT your FEIN/TIN)
If you do not have a DUNS # or need further information please go to http://www.whitehouse.gov/sites/default/files/omb/grants/duns_num_guide.pdf
Sponsor Name:
Street 1:
Street Number
Street Name
Street 2:
City:
State:
Zip:
County:
Phone: x numbers only; do not use hypens "-" or parentheses "() in phone numbers"
Fax: x numbers only; do not use hypens "-" or parentheses "() in phone numbers"
Type
FEIN
Authorized Rep
"Authorized Representative" is the person who is legally and administratively responsible for your institution.
First:
Middle:
Last:
Title:
Phone: x
Fax: x
E-mail:
 








numbers only; do not use hypens "-" or parentheses "()" in phone numbers.
Contact
A "Contact" only provides someone who ISBE may contact when the "Authorized Representative" is not available.
First:
Middle:
Last:
Title:
Phone: x
Fax x
E-mail:
Food Service
Total number of sites administered New sponsors can initially operate two sites their first year. Conctact SFSP staff with any questions @ (800)545-7892.
Date first site opens
Date last site closes
Method of meal preparation
Meal Preparation Location
Submit
By clicking the Submit button, you certify that all information presented in this form is true and correct to the best of your knowledge. If you agree to these terms, please press Submit.