Request to Participate in the Restaurant in the SNAP Restaurant Meals Program

The Restaurant Meals Program is now available statewide. Please complete the survey below.

Please allow up to 10 business days for a response.

Restaurant Information

Restaurant Name:

Address Line 1:

Address Line 2:

City, State, ZIP:

County:

Contact Name:

Contact Email:

Contact Phone:

SNAP Restaurant Meals Program Participant Criteria

Are you willing to complete a Memorandum of Understanding (MOU) with the State of Illinois?

Are you willing to apply a 10% discount to all menu items?

Do at least 50% of your total sales come from food?

Is your restaurant fully accessible to people with disabilities?

Is sit-down seating available at your establishment?

Do you operate as a bar or tavern?

What healthy meal options does your restaurant offer?

How many additional restaurant locations will be included?

Additional Information:

How did you hear about the Restaurant Meals Program?

Verification: 4 + 6 =

Attestation

I attest that the information I have stated and provided in this form are true and accurate. By signing below, I declare under penalty of perjury under the laws of the United States of America and the State of Illinois that the information I have given on this form is true, correct and complete to the best of my knowledge. I understand that if I knowingly give wrong information or leave out information that I know to be true, I can be fined and I can be charged with a crime.

USDA Nondiscrimination Statement In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity.

I have read, understood and accept the penalty statement above.