CACFP Disaster Milk and Meal Flexibility Request

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CACFP Disaster Milk and Meal Flexibility Request This request form is strictly for CACFP facilities that are under the sponsorship of Youth Educational Services, Inc. (YES Inc). Please contact Bright from the Start or your sponsor for flexibility during disasters. DECAL state-level flexibility will only be granted to those impacted organizations, sites, or individuals located in a state in which a “State of Emergency” has been declared. In determining whether a “State of Emergency” exists in Georgia, the definition of “State of Emergency” provided in Part I of this document shall be applied. FOOD COMPONENT- You may make requests for the following: - Services without milk or an alternate form of milk (e.g., canned or dry) - Special variations in menu planning and meal pattern (requires permission from USDA) MEAL SERVICE - You may request the following: - Temporary changes in the time of meal service Complete the form below for us to submit your request to DECAL. If we have further questions, Please contact us immediately for further guidance. 770-938-3188 Once submitted, you will have CONDITIONAL permission to make the substitution; however, you will not be reimbursed for meals if DECAL or USDA-FNS reject your request. If you have any questions, contact YES Administration.
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Your Business Name* This field is required.Child Care Center Name
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Your Name* This field is required.
First Name
Last Name
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Email* This field is required.Email (A copy of your responses will be sent to this email. Make sure it is correct.)
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Program Type* This field is required.You may select more than one
Child Care Center
Adult Care Center
At-Risk Afterschool Program ONLY
Homeless Shelter
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Address* This field is required.
Street Address
Street Address Line 2
City
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Zip Code
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Country
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County/School DistrictEx. (Dekalb County)
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Telephone Number* This field is required.Phone Number to contact you directly about this request
Area Code
Phone Number
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Mobile/Alternate Number* This field is required.
Area Code
Phone Number
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Center Operating HoursUpdated hours due to COVID-19 (if applicable)
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MEAL SERVICE REQUEST- Are you requesting a TEMPORARY meal time change?
YESNO
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Breakfast Time (If changed due to COVID-19 (if applicable)
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Lunch Time (If changed due to COVID-19 (if applicable)
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PM Snack Time (If changed due to COVID-19 (if applicable)
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Dinner Time (If changed due to COVID-19 (if applicable)
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Evening Snack Time (If changed due to COVID-19 (if applicable)
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Nearest Elementary School to the CenterPLEASE NOTE: Many county schools will provide lunch for pick up for anyone 18 years of age or younger between the hours of 11 a.m. and 1 p.m. These lunches will be provided at no cost to the individual through the federal School Nutrition Program. The student or child must be present to receive the meal. A child does not have to be a student at the school site to receive a meal.
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FOOD COMPONENT REQUEST- Describe the nature of your request. Be very specific with details and vendors you have visited. What is the emergency? What difficulties are you having? What have you recently done to purchase the exact food components you need? If milk is an issue, what type of milk are you having difficulty finding?Example: All of the store are closed in my area. Whole grain options are not available, we would like to get approval to serve non-whole grain options.
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Item 1. What are you proposing to substitute in place of the item(s) you cannot find? Example: We can not find 1% Fluid Milk in the stores. We are asking for a waiver to be approved to use 2% milk instead.
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Item 2. What are you proposing to substitute in place of the item(s) you cannot find?Example: We can not find 1% Fluid Milk in the stores. We are asking for a waiver to be approved to use 2% milk instead.
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Item 3. What are you proposing to substitute in place of the item(s) you cannot find?Example: We can not find 1% Fluid Milk in the stores. We are asking for a waiver to be approved to use 2% milk instead.
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Item 4. What are you proposing to substitute in place of the item(s) you cannot find?Example: We can not find 1% Fluid Milk in the stores. We are asking for a waiver to be approved to use 2% milk instead.
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* This field is required.
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Name of Authorized Personnel
First Name
Last Name
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