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Child and Adult Care Food Program Intake Form
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* Indicates required question
Institution Name:
*
Your answer
Institution's Mailing Address:
*
Your answer
County:
*
Your answer
Name of Director or Main Contact:
*
Your answer
Director or Main Contact’s Email Address:
*
Your answer
Director or Main Contact’s Phone Number:
*
Your answer
FEIN:
*
The tax ID number (FEIN) is required for participation.
Your answer
Type of Agency:
*
For-profit
Nonprofit
Other:
Is your institution open and running?
*
Yes
No
If your institution has not opened yet, when will it be up and operating?
Your answer
Is the site(s) licensed with the Colorado Department of Early Childhood (CDEC)?
*
A child care license is required for participation in the CACFP.
Yes
No
Do you have more than one site?
*
Yes
No
Which type of care do you provide?
*
Child and Infant Care
Adult Daycare Center
Afterschool Program
Headstart or Early Headstart
Homeless/Emergency Shelter
School Food Authority
How did you hear about the CACFP?
*
The internet or CACFP website.
State agency staff.
Word of mouth from someone you know.
Nutrition or early childhood event/conference.
Other:
What aspects of CACFP interests you?
*
Nutrition education to support healthy development of young children.
Money to cover the cost to prepare food.
Improve quality of childcare.
Other:
Required
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