Skip to Main Content
Do Not Show Again
How Do I...
Select a Category
Bayfield County Fair
Forestry & Parks
Land & Water Conservation
University of Wisconsin Extension
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Elder Nutrition Program Partnership survey
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
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.
1. What is the name and address of your business?
2. Contact information of the owner/manager:
3. Please upload a copy of your current license or certification
4. Have you had any health code violations in the last 3 years?
Yes-describe violation below
Health code violation description
5. What capacity do you have to prepare meals for this program? Please provide a minimum number of meals if required, a maximum number of meals that can be provided, how many days per week meals can be provided, and/or if meals can be provided all year or only part of the year. Please be as specific as possible.
6a. Do you currently have the staff capacity to prepare meals for this program?
No-answer 6b. below
6b. How long would it take to begin to provide meals?
7. Do you have the capacity to provide take-out meals from your location for this program?
8. Do you have the capacity to deliver meals from your location?
9. Do you have an invoicing system that can break down raw food costs?
10. After reviewing the dietary criteria below, please upload a minimum of 5-day sample menu
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
Submit and Print
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow