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Forms and completed sample forms for use by Child and Adult Care Food Program (CACFP) sponsors.

Eligibility Materials

Adult Component Eligibility Materials
Participant eligibility materials for the adult component of the Child and Adult Care Food Program (CACFP).

Child Care Center Eligibility Materials
Participant eligibility materials for the child care component of the CACFP.

Day Care Home Eligibility Materials
Provider and participant eligibility materials for the day care home component of the CACFP.


Certification of Principals and Board Members (DOC)
Form used to gather information from principals in organizations applying or reapplying to participate in the Child and Adult Care Food Program. (See Management Bulletin 04-201 for more information.)

Emergency Shelter Daily Roster (DOC)
Used to record the meals served to the eligible shelter residents.

Emergency Shelter Monthly Roster (DOC)
Used to document adults with disabilities that may be served and claimed, provided that the shelter serves a majority of residents 18 years of age or younger.

Medical Statement to Request Special Meals and/or Accommodations (DOC)
CNP 925 - This form is used by parents/guardians to have a medical authority prescribe special meals, or accommodations during meals, which are necessary because of a disability or medical reason.
Available Translations of the Medical Statement to Request Special Meals and/or Accommodations

Parental Request for a Fluid Milk Substitution for Children in Child Care (DOC)
Used by parents to request a fluid milk substitute due to a medical or other special dietary need; see MB USDA-CACFP-20-2011 for more information.

Questions:   Nutrition Services Division | 800-952-5609
Last Reviewed: Friday, March 17, 2017
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