Printable Forms

Attendance and Meal Count Sheet

CACFP Healthier Menus Fall/Winter

CACFP Healthier Menus Spring/Summer

Civil Rights

Enrollment Form

Family Income Eligibility Form

Infant Menu

Infant Offer Form

Meal Modification Form

Menu-Age 1 and over

Provider Income Eligibility Form

Site Sheet

Attendance and Meal Count Sheet

CACFP Healthier Kansas Menus Fall/Winter

CACFP Healthier Kansas Menus Spring/Summer

Civil Rights

Enrollment Form

Family Income Eligibility Form

Infant Menu

Infant Offer Form

Meal Modification Form

Menu - 1 year and older

Provider Income Eligibility Form

Site Sheet



Nutrition Plus, Inc.

USDA Nondiscrimination Statement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) Mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410;

(2) Fax: (202) 690-7442; or

(3) Email: [email protected]

This institution is an equal opportunity provider.

© 2017 Nutrition Plus, Inc.

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