Step 1 of 2

What meal would you like to serve?*

Fresh Meals (Must serve at least 30 meals per day)

Shelf Stable “Super Snack” Meals (Must serve at least 200 per month)

1. SITE NAME*

2. SITE PHYSICAL ADDRESS (this is the location of food service):*

Street Address City State ZIP Code

COUNTY*

County

3. SPECIAL DIRECTIONS TO SERVING LOCATION (ie: Building or Room #, Entrance, Parking, etc.):*

Include here specifications on where drivers should be leaving your delivery. Some examples of what to include are: building or room number, what entrance to use, where they can park, any building entry instructions/passcodes/phone numbers they would need, if staff will be on site to meet them, etc.

4. SITE MAILING ADDRESS (Leave blank if it is the same as address in question 2):

Street Address City State ZIP Code

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5. SITE CONTACT INFORMATION

Though duties may be delegated, this listing should be the person(s) responsible for the site and all program paperwork. At least one of these individuals will be required to attend training.

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Primary Contact

First Name*

Last Name*

Phone Number*

Alternate Phone

Email*

Title*

Secondary Contact

First Name*

Last Name*

Phone Number*

Alternate Phone

Email*

Title*

6. DOES THIS SITE HAVE AN ACTIVE CHILDCARE LICENSE?*

If YES – you must submit a copy of your current childcare license with your application. If NO – you must complete the CDPHE form titled, Child and Adult Care Food Program License Exemption Checklist located at the end of this application.

Yes

7. AGE RANGE OF PARTICIPATING CHILDREN*

Must be between 5 and 18 years.

8. HAS THIS SITE PREVIOUSLY PARTICIPATED IN THE CACFP PROGRAM UNDER A SPONSORING ORGANIZATION?*

IF YES, PREVIOUS INSTITUTION’S NAME AND DATES OF PARTICIPATION.

YES

Names & Dates

9. START DATE OF MEALS

END DATE OF MEALS

The start date cannot be before the start of the 2024-2025 school year. The end date cannot be after school has ended for the summer. The Food Bank of the Rockies kitchen will be CLOSED August 12th – August 16th and fresh meals will be unavailable at this time. Shelf stable packaged meals are available upon request during the closure.

10. OPENING TIME

CLOSING TIME

These are the hours your organization is open. They may differ from the hours you serve meals.

11. ANTICIPATED MONTHS MEALS WILL BE SERVED (check all that apply):

12. DAYS OF THE WEEK MEALS WILL BE SERVED (check all that apply):

Monday

Tuesday

Wednesday

Thursday

Friday

13. PLANNED MEAL SERVICE TIME - START TIME*

PLANNED MEAL SERVICE TIME - END TIME*

Service of meal must be after school has let out for the day and you are in “after school programs.” Service of meal must begin at approved serving time. Any changes to days and times must be communicated to Food For Kids staff in advance.

14. ANTICIPATED CLOSURE DATES AND/OR CHANGES TO SERVICE DURING THE MONTHS MEALS WILL BE SERVED:*

Please list any variations in service or dates meals will not be served, including school breaks, holiday, etc.

15. ANTICIPATED NUMBER OF CHILDREN TO BE SERVED DAILY*

This number can be updated after the start of the program. Any changes should be communicated to Food For Kids staff as soon as possible.

16. SCHOOL ELIGIBILITY

Nearest school(s) serving your geographic area where 50% or more of the students qualify for Free and Reduced meals.

School Name*

% Receiving Free and Reduced Meals*

Source of Information*

Here is a link to help you determine and locate school eligibility: https://www.cde.state.co.us/cdereval/pupilcurrent

17. INDICATE TYPES OF AFTER-SCHOOL ACTIVITIES PROVIDED (check all that apply)*

Other

18. DATE OF LAST HEALTH DEPARTMENT INSPECTION*

Health Department Inspections are required for ALL SITES, both new and returning. For new sites, health inspections need to be within the past 12 months. A copy of your inspection must be included with this application for ALL SITES.

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19. RACIAL AND ETHNIC DATA

Total must equal anticipated number of children listed in Question 15. Please use whole numbers, not percentages. Complete to the best of your knowledge.

Number of Participating Not-Hispanic or Latino Children*

Number of Participating Hispanic or Latino Children*

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20. PARTICIPANT RACE DATA:

20. PARTICIPANT RACE DATA

Total must equal anticipated number of children listed in Question 15. Please use whole numbers, not percentages. Complete to the best of your knowledge.

Number of Participating American Indian or Alaska Native Children*

Number of Participating Asian Children*

Number of Participating Black or African American Children*

Number of Participating White Children*

Number of Participating Native Hawaiian or Other Pacific Islander Children*

MANDATORY TRAINING

All staff that are responsible for serving and administering the CACFP program must attend one training date. If your site does not attend a training, you will not be able to participate with the CACFP program.

Training will be approximately one hour, via zoom. Times and dates will be offered throughout the school year and schedules sent to you as soon as your site is approved for CACFP program. They must be completed at least TWO WEEKS PRIOR to your site’s desired start date.

List names of site server(s) with a contact phone number and/or email address:

Name

Phone

Name

Phone

CACFP Program Application

IMPORTANT DATES / DEADLINES

ALL SECTIONS MUST BE COMPLETED. INCOMPLETE APPLICATIONS MAY DELAY THE START OF THE PROGRAM.

16. SCHOOL ELIGIBILITY

PARTNER AGREEMENT & NOTICE TO PARTNER