Printable Forms

Attendance and Meal Count Sheet

CACFP Healthier Menus Fall/Winter

CACFP Healthier Menus Spring/Summer

Civil Rights

Direct Deposit Form

Enrollment 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




USDA Nondiscrimination Statement:

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

mail:

U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410; or

fax:

(833) 256-1665 or (202) 690-7442; or

email:

[email protected]

This institution is an equal opportunity provider.

© 2017 Nutrition Plus, Inc.

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