Nutrition, Transportation, and Support Services - Forms and Information

Contact the NTS Coordinator at 465-4876 or FAX 465-1170, or by email for information, questions, or if having problems downloading any forms or documents. Email: kristin.cox@alaska.gov.

Forms

Planning Forms

NTS RFP 2019 Service Definitions
Planned Services & Expenditures (PSE) (revised)
The PDF form is posted as an example only; please complete the form in GEMS or request a form from your grant program manager
Logic Model—Performance Framework
Logic Model—Performance Framework (PDF fillable form)
19 Terms and Conditions
17 Annual Title VI Part A, B, Part C and NSIP Cash Award

Annual Consumer Screening Forms

Consumer Characteristics (revised 2/11/21) (PDF fillable form)
Determine Your Nutritional Needs

Reporting

2020 NTS CFR2
The PDF form is posted as an example only; please download the form from GEMS or request the form from your grant program manager.
2020 CFR2 Statewide
The Word form is posted as an example only; please download the form from GEMS or request the form from your grant program manager
19 NTS Biannual Progress Report (PDF fillable form)
You may also download this form from GEMS.
FY 20 NSIP Claim form for Reimbursement
The Word form is posted as an example only; please request the form from your grant program manager.

Meals

Cycle Menu Forms
Cycle Menu Forms
Food Safety For Home Delivered Meals
- Someone must be home to accept deliveries
- Store you home delivered meal safely
NSIP Claim For Reimbursement

Information

Provider Administration

Provider Operations

Meals

Contact

Kristin Cox, ND, Health Program Manager II
Senior and Disabilities Services (DSDS)
PO Box 110680
Juneau, Alaska 99811-0680
Phone: 907-465-4786 Fax: 907-465-1170