Child & Adult Care Food Program (CACFP) Sponsor Inquiry Registration Form

Section A - Sponsoring Organization Information

* = Required fields   * Sponsor Name:

* Contact Person Name/Title:

* Address:

* City/State:

* Zipcode:

* County:

* Area Code and Day Time Telephone Number:  Format 302-555-5555

* Area Code and Evening Telephone Number:  Format 302-555-5555

Email address:

Please Indicate your Sponsoring Organization's Tax Status (501 c 3): Public or Private Nonprofit Program Yes No

For-Profit (Proprietary) Program Yes No

Learned about CACFP from: (Please check one.) Participating Sponsor Web Site News Release Other

Have you participated in other Child Nutrition Programs in the past three years? (Check all that apply.) National School Lunch Program Summer Food Service Program for Children Nutrition Program for the Elderly Child & Adult Care Food Program Special Milk Program Emergency Food Assistance Program Commodity Food Program  Other:

Section B - Sponsoring Organization Services

Age Range Served (Please check all that apply) Infants Preschool School Age Youth 13-18 yrs

Number of Sites:

Current Number of Participants Enrolled:

License Capacity:

Meal Types to be Served Breakfast AM Snack Lunch PM Snack Supper Eve Snack

Planned Activities:

Days of Operation (Please check all that apply) Mon Tues Wed Thurs Fri Weekends Holidays

Food Service Arrangements/Considerations (Please check all that apply) On Site Central Kitchen School Food Service Agreement Food Service Management Company Contract

Comments/Limitations:

C - Eligibility (For State CACFP Office Use Only)

Eligibility Status (please check one) Area Eligible Using Census Data Using Income Eligibility Applications

Response Contact by: (please check one) Phone Letter/Information Packet In Person Web Site Other

CACFP...integrating nutritious meals …making a difference in Delaware communities.