CACFP / SFSP Site Application

CACFP / SFSP Site Application
Site Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County

DimmitStarrJim HoggVal VerdeKinneyWebbMaverickZapata
Child Care Cener Type*

Child CareHead StartOutside School HoursAt-Risk Afterschool Care CenterEmergency Shelter
Tax Status*

For ProfitNon-Profit
Does the Site have a kitchen or serving area?*

Kitchen with StoveKitchen with NO StoveOnly Serving AreaOther
Site Contact

Person in charge of this center on a daily basis
Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Additional Center Contact

Alternate person in charge of this center on a daily basis
Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Planned Schedule
What Months do you plan to have meal service?*

JanauryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
What Days do you plan to have meal service?*

MondayTuesdayWednesdayThursdayFriday
From what time to what time do you plan on having the meal service?*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Meal Service
What Meal Service are you interested in serving at this site? (Can only choose up to 2 options and must have at least a 2 hour gap between meal services)*

BreakfastAM SnackLunchPM SnackSupperEvening Snack
Anticipated Children Participation*
Enrichment Activities
What Enrichment Activities does the site offer the children? Ex: Computer Lab/ Homework help, Arts/Crafts, etc.*
Should be Empty:

CACFP / SFSP Site Application

Site Contact

Additional Center Contact

Planned Schedule

Meal Service

Enrichment Activities