Documents/Forms

Authorized Signatures

• Authorized Signatures Change Form
• Authorized Signatures Change Form Instructions

Crediting Worksheets

• Adult Centers Worksheet 1: Crediting Purchased Grains in the CACFP
• Adult Centers Worksheet 2: Crediting Breakfast Cereals in the CACFP
• Adult Centers Worksheet 3: Crediting Cooked Breakfast Cereals in the CACFP
• Adult Centers Worksheet 4: Crediting Family-size Recipes for Grains in the CACFP
• Adult Centers Worksheet 5:Crediting Quantity Recipes for Grains in the CACFP
• Adult Centers Worksheet 6:Evaluating Processed Fruits and Vegetables for Compliance with the Recommended Nutrition Standards for CACFP Adult Centers
• Adult Centers Worksheet 7: Evaluating Soups for Compliance with the Recommended Nutrition Standards for CACFP Adult Centers
• Adult Centers Worksheet 8: Evaluating Meat/Meat Alternates for Compliance with the Recommended Nutrition Standards for CACFP Adult Centers
• Adult Centers Worksheet 9: Crediting Yogurt in the CACFP
• Adult Centers Worksheet 10: Nutrient Analysis of Recipes

Civil Rights 

• CACFP Civil Rights Beneficiary Data Collection Form
• CACFP Civil Rights Potential Beneficiary Data Collection Form
• CACFP Civil Rights Pre-award Survey
• Civil Rights in Child Nutrition Programs (CSDE webpage)

Enrollment Form

• CACFP Enrollment Form for Adult Centers

Food Safety

 

• Alternate QFO Statement
• Food Safety for Child Nutrition Programs (CSDE webpage)
• Food Service Employee Training Record for Sanitation and Food Safety 
• On-site Training Record for Sanitation and Food Safety
• Qualified Food Operator (QFO) Responsibilities for Connecticut Child Nutrition Programs
• Refrigerator and Freezer Temperature Control Record

Income and Expenditure Report

• CACFP Sample Nonprofit Status Income and Expenditure Report 
• CACFP Sample Nonprofit Status Income and Expenditure Report: Instructions

Income Eligibility

• Income Eligibility Application Form for Adult Day Care Centers (English)
• Income Eligibility Application Form for Adult Day Care Centers (Spanish)
  • Programa de Alimentos para el Cuidado de Niños y Adultos (CACFP) Solicitud de elegibilidad según los ingresos para los centros de cuidado diurno para adultos
• Income Eligibility Application Form for Adult Day Care Centers Instructions (English)
• Income Eligibility Application Form for Adult Day Care Centers Instructions (Spanish)
  • Programa de Alimentos para el Cuidado de Niños y Adultos (CACFP) Instrucciones para completar la solicitud de elegibilidad según 
    los ingresos para los centros de cuidado diurno para adultos 
• Income Guidelines for Child Nutrition Programs (CSDE webpage)
• Sample Household Letter for Nonpricing Adult Day Care Centers (English)
• Sample Household Letter for Nonpricing Adult Day Care Centers (Spanish)
  • Programa de Alimentos para el Cuidado de Niños y Adultos (CACFP) Carta al grupo familiar de muestra para los centros de cuidado diurno para adultos

Medical Statements

• Medical Statement for Meal Modifications in CACFP Adult Day Care Centers (English)
• Medical Statement for Meal Modifications in CACFP Adult Day Care Centers (Spanish)
  • Declaración médica para la modificación de alimentos en los centros de cuidado diurno para adultos del Programa de Alimentos para el Cuidado de Niños y Adultos (CACFP)
• Guidance and Instructions: Medical Statement for Meal Modifications in CACFP Adult Day Care Centers (English)
• Guidance and Instructions: Medical Statement for Meal Modifications in CACFP Adult Day Care Centers (Spanish)
  • Orientación e instrucciones: Declaración médica para la modificación de alimentos en los centros de cuidado diurno para adultos del Programa de Alimentos para el Cuidado de Niños y Adultos (CACFP)
    
     

Menu Forms

• Adult Centers Menu Form for AM Snack, Lunch, and PM Snack
• Adult Centers Menu Form for Breakfast, Lunch, and Snack (AM or PM) 
• Adult Centers Menu Form for Lunch and Snack (AM or PM)
  
  

Monitoring

• Monitoring Review Form for CACFP Centers

Production Records

• Production Record for Adult Centers: AM Snack, Lunch, and PM Snack 
• Production Record for Adult Centers: Any Meal
• Production Record for Adult Centers: Breakfast, Lunch, and Snack (AM or PM) 
• Production Record for Adult Centers: Lunch and Snack (AM or PM)

Standardized Recipes

• CACFP Standardized Recipe Form