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Applications & Forms

Child and Adult Care Food Program

How to Apply - Complete instructions for:
Adult Day Care Centers - Licensed
After School Programs
Child Care Centers - Licensed or License-Exempt
Homeless Shelters
Family Child Care Homes - Licensed

CACFP Applications & Forms

Protected Word doc

CACFP 1   Application and Management Plan for Sponsoring Organizations of Multiple Centers in the Child and Adult Care Food Program (CACFP)

pdf       doc

CACFP 2   Application for Participation in the Child and Adult Care Food Program (CACFP)

pdf

CACFP 205   Income Eligibility Form for Child Care Centers

pdf       doc

CACFP 208   Statement of Affiliation for Non-Profit Organizations

pdf       doc

CACFP 209   Budget for Independent Centers

pdf       doc

CACFP 210   Menus required with all CACFP Applications

pdf       xls

CACFP 213   Daily Attendance Record

pdf       doc

CACFP 214   Documentation of Non-profit Food Service (Updated - Summary of Salary Expenses)

pdf       doc

CACFP 215   Individual Infant Meal Record 0 Through 3 Months

pdf       doc

CACFP 216   Individual Infant Meal Record 4 Through 7 Months

pdf       doc

CACFP 217   Individual Infant Meal Record 8 Through 11 Months

pdf       doc

CACFP 218   Menu - USDA Requirements (5 Days letter size)

pdf       doc

CACFP 218 A   Menu - USDA Requirements 7 Days (letter size)

pdf       doc

CACFP 218 AA   Menu - USDA Requirements 7 Days (legal size)

pdf       doc

CACFP 218 B   Menu - USDA Requirements For Shelters (letter size)

pdf       doc

CACFP 218 BB   Menu - USDA Requirements For Shelters (legal size)

pdf       doc

CACFP 220   Enrollment Roster

pdf       doc

CACFP 221   Time In/Time Out Record

pdf       doc

CACFP 222   Training Documentation

pdf      doc

CACFP 223   Production Record Breakfast and Lunch/Supper

pdf       doc

CACFP 224   Monthly Attendance Time In/Time Out Record

pdf       doc

CACFP 225   Meal Count (Monday thru Friday - letter size)

pdf       doc

CACFP 225A   Meal Count (Sunday thru Saturday - legal size)

pdf       doc

CACFP 226   Beneficiary Data Report

pdf       doc

CACFP 227   Medical Food Substitution Record

pdf

CACFP 229   Enrollment Form – Centers

pdf

CACFP 230   Enrollment Form – Homes

pdf       doc

CACFP 404   Sponsored Centers Site Visit Report

pdf

CACFP 501   Income Eligibility Form for Adult Care Centers

pdf

CACFP Income Eligibility Guidelines

pdf

Vendor Input Form – SAM II (for new applicants only)

pdf

Vendor ACH/EFT Application – SAM II (for direct deposit)

pdf      doc

CACFP Web Access Application Form

 

Contracting for Food Service - Instructions and Prototypes

pdf      doc

Daily Menu Planning and Production Record for At-Risk Programs

pdf

Food Chart - Adults

pdf

Food Chart - Children

pdf

Food Chart - Infants

pdf

Four Menu Components

pdf       doc

Infant Feeding Preference - Centers

pdf       doc

Infant Feeding Preference - Homes

pdf       doc

Meal Count Record (Tally) for At-Risk Programs

pdf

Policy Statement (Pricing Centers Only)

pdf       doc

Snack and Supper Menus for At-Risk Programs