Daycare Provider Forms
Below you’ll find all of CCNI’s printable CACFP forms and documents. Please contact our office with questions. If you do not have access to a printer and would like forms mailed to you, click here to contact us!
Child Enrollment Form
Use this form to enroll all children participating on the Child and Adult Care Food Program with CCNI. Parents must sign and date within the month that participation is to begin. Send to CCNI with claim. Annually, children must be re-enrolled. This can be done by mail OR renew enrollments online!
Read and follow instructions for automatic deposit of food program reimbursements right into the bank! No more driving to the bank for deposits, or losing checks before they get to the bank! This is a life-saver!
Use this form for extra clarification on claims (children schedules, split shift schedules, adding meal services, etc)
License Continuation Form
Your county childcare licenser should complete this form if your childcare address changes or if your re-licensing is taking longer than expected.
Special Diet Statement Disability
Children who have a disability or a medically disabling reaction to a food should have a Special Diet Statement for a Participant with a Disability completed. When this form is completed and signed by a licensed physician, the provider is required to provide the substitutions for the child. Substitutions on this form can include creditable and non-creditable foods.
Special Diet Statement
Children without disabilities can request deviations from the meal pattern guidelines, but the provider is not required to provide those changes. The Special Diet Statement for a Participant without a Disability can be completed and signed by an authorized medical authority. Substitutions listed on this form must be creditable.
Request for Non Diary
Certain soy milks are creditable as a substitution for cow’s milk. Only the soy milks listed specifically on the Request for Non-Dairy form may be substituted without a Special Diet Statement on file.
If for any reason, a parent does not want their child to participate on the CACFP they can fill out the decline form and discuss with their provider meal options for when the child is in care.
Use this form when you need a formula statement but not a whole new enrollment.
2017-18 Provider Household Income Statement
This form is used for providers to apply for Tier I rates. If a provider qualifies according to these guidelines, all meals served in the home are at the higher, Tier I level. It may help qualify a brand new provider for receiving a licensing grant from CCNI to help with costs associated with starting a newly licensed child care home.
2017-18 Participating Families Household Income Statement
This form will qualify families with children enrolled in a family child care home so their providers can receive the higher (Tier I) reimbursement rate for meals & snacks their children consume in the child care home.
Infant Menu PDF
Fill out this form with the infant(s) information and meal components served. Be sure to keep a copy for your records!
Regular Menu PDF
Fill out this form with the meal components served. Be sure to keep a copy for your records!
Meal Count PDF
Fill out this form with the children(s) information as well as meals served. Remember to only claim two meals and one snack per child per day OR two snacks and one meal per child per day. Be sure to keep a copy for your records!
Administrative Review Appeal Form
Please use this link to review the Appeal Process.
Current and Past Newsletters