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Child and Adult Care Food Program


Note: 2018-2019 Application Due Date is September 7, 2018..

Application Documents - UPLOADS ALL PROGRAMS
Form Format
Application Upload Documents Attachments to the Application for Participation - Sponsors, Word document
Administrative Budget Worksheets Word document
At-Risk Supper Meals Program Application Word document
CACFP Forms
Form Format
Center Application & Agreement Word document
Categorical Eligibility 2018 ategorical Eligibility 2009, Word document
Center Monitoring Review Form Center Monitoring Review Form, Word document
FDCH Forms
Form Format
FDC Home Monitoring Review Form FDC Home Monitoring Review Form, Word document
Provider Appeals Process Acrobat Reader
Parent/Guardian Application and Directions
Form Format
Adult Income Eligibility Form Word document
Child and Adult Client Income Application for Child Care Centers & Family Day Care Homes Word document
Adult Verification Form Word document
Child and/or Adult Enrollment Form Acrobat Reader
Child Care/Family Day Care Home Income Eligibility Form Parent Application (CACFP, FDC Tier I/Tier II, Provider Tier I/Tier II), Word document
Child or Adult Income Eligibility Instructions Parent Application Directions (CACFP, FDC Tier I/Tier II, Provider Tier I/Tier II), Word document
Parent Letter - Income Eligibility Word document
Child Care/Family Day Care Home Income Eligibility Form Spanish Acrobat Reader
Tier I and II - Reimbursement Determination Notification Tier I and II - Notification, Word document
Tier I and II - Selection for Verification Tier I and II - Selection for Verification, Word document
Provider Forms
Form Format
New Provider Determination Tier I Income Worksheet - FDCH New Provider Determination Tier I Income Worksheet, Acrobat Reader
Provider Application and Agreement - FDCH Provider Application and Agreement, Word document
Provider Application Instructions Provider Application Instructions, Word document
Tier II Provider Notification and Election Form Provider Tier II-Tier I Eligibility and Notification, Word document
Additional Forms
Form Format
2018-2019 Income Eligibility Guidelines Acrobat Reader
FDCH Menu Reimbursement Worksheet/Menu form Excel
5 Day Reconciliation Form - Child Care Centers ONLY Acrobat Reader
5 Day Reconciliation Form Policy and Procedure of Meal Counts 5 Day Reconciliation Form, Acrobat Reader
5 Day Reconciliation Form - Family Day Care Homes ONLY Acrobat Reader
50% Eligibility List 2018 50% Eligibility List, Acrobat Reader
For Profit CCC Enrollment & Eligiblity Determination Word document
Definitions Requirements Page Acrobat Reader

Special Dietary Medical Statement Form

Acrobat Reader
W-9 Form W-9 Form, Word document
At Risk Snack Monitoring form Acrobat Reader
At Risk Monitoring Review Attastation Snack/Supper Word document
New Center Documenations Required Word document

Microsoft Excel Symbol Microsoft Excel format. You can download a free reader from Microsoft.

Acrobat Reader Symbol Acrobat Reader format. You can download a free reader from Adobe.

Microsoft Word Symbol Microsoft Word format. You can download a free reader from Microsoft.


New Hampshire Department of Education
101 Pleasant Street | Concord, NH | 03301-3494
Telephone: (603) 271-3494 | TDD Access: Relay NH 711