Forms - Child and Adult Care Food Program (CACFP)




Weekly Field Memo \| Calendar of Events \| School Directories

PROGRAMS & SERVICES:
CHILD NUTRITION:
CHILD & ADULT CARE FOOD PROGRAMS:
FORMS
(Updated 4/11/13)

Download forms for the following:

ENROLLMENT & ELIGIBILITY FORMS & RESOURCES

CACFP Forms
Form ID	Form Name	Word	PDF	Excel

	CACFP Reimbursement Rates	-	PDF	-
20	CACFP Enrollment Form	-	PDF	-
25	Income Eligibility Guidelines	-	PDF	-
75	Attendance Record	-	PDF	Excel

Child Care Forms
	Income Eligibility Form - Tier I (NOTE: Print on light yellow)	-	PDF	-
	Income Eligibility Form - Tier II (NOTE: Print on pink)	-	PDF	-
15-1	Notice to Households – Tier 1 Day Care Homes	Word	PDF	-
15-2	Notice to Households – Tier 2 Day Care Homes	Word	PDF	-
30	Child Care Income Eligibility Form (NOTE: Print on light blue)	-	PDF	-
35N	Notice to Households – Parents & Guardians (Non-pricing)	Word	PDF	-
35P	Notice to Households – Parents & Guardians (Pricing)	Word	PDF	-
50	Child Care Master List			Excel

Adult Forms
40	Income Eligibility Form – Adult Care (NOTE: Print on gray)	-	PDF	-
45	Notice to Households – Adult	Word	PDF	-
55	Adult Master List	Word	PDF	-

MEAL PATTERNS & RECORD KEEPING FORMS

CACFP Forms
Form ID	Form Name	Word	PDF	Excel

	Meal Planning Templates	Word	PDF	-
	Non-creditable Foods List	-	PDF	-
120	Meal Count Sheet	Word	PDF	Excel
120FRP	Meal Count Sheet by Category	Word	PDF	-

Child Care Forms
180	Child Care Meal Pattern	-	PDF	-
100	Child Weekly Meal Record	Word	PDF	Excel
100S	Child Supper & Evening Snack Record	Word	PDF	-
110	Child Snack Record	Word	PDF	Excel
150	Expenditure Report	-	PDF	Excel
165	Infant Meal Pattern	-	PDF	-
115	Child Breakfast & Snack Record	Word	PDF	Excel
160A	Infant Meal Record (0-3 months)	Word	PDF	-
160B	Infant Meal Record (4-7 months)	Word	PDF	-
160C	Infant Meal Record (8-11 months)	Word	PDF	-

Adult Forms
210	Adult Meal Pattern	-	PDF	-
200A	Adult Weekly Meal Record	Word	PDF	-
200S	Adult Supper & Evening Snack	Word	PDF	-

PROGRAM ADMINISTRATION

Form ID	Form Name	Word	PDF	Excel

	Building for the Future Poster	-	PDF	-
	CNP Password Form	-	PDF	-
	Planned Monitoring Schedule	Word	PDF	-
170	Medical Statement Form	-	PDF	-
300	Site Review Forms for Sponsors	Word	PDF	-
305	Monitoring Log	Word	PDF	-
310	Training Certification Sheet	Word	PDF	-



	Like us on Facebook Follow us on Twitter Watch our Videos on YouTube

	Proud member of New England Secondary School Consortium




A Vermont Government Website Copyright © 2013 State of Vermont. All rights reserved
Accessibility Policy + Privacy Policy + Disclaimers