Phone: (402) 684-3366Fax:(402) 684-3677
102 East South StreetBassett, NE 68714
E-mail: rchospital@rockcountyhospital.com
Please complete this form to the best of your ability.
High School
College
Rules for acceptance and participation in the program are the same for everyone without regard to race, color, national origin, handicap, age or sex. Any person who believes he or she has been discriminated against in this program should write to: Administrator, Food & Nutrition Service, 3101 Park Center Drive, Alexandria, VA 22302.