Child and Adult Care Food Program New Applicant Intake Form
This form provides basic information for CACFP to determine whether an institution would qualify for participation in the program. This is not an application for the program.
Please return completed form by email to Julie.Pfankuch@state.co.us or fax to 303-756-9926
For questions or more information, please call the main line at 303-692-2330.
Date of inquiry *
MM
/
DD
/
YYYY
Institution Name
Your answer
Do you have more than one center or site? *
Name of director or main contact *
Your answer
Main contact's email address *
Your answer
Main contact's phone number *
Your answer
Type of agency *
Which type of care do you provide? *
FEIN (Federal Employer Identification Number) (*Required) *
Your answer
Street Address (We do not accept PO boxes) *
Your answer
City *
Your answer
Zip Code *
Your answer
County *
Your answer
Is the site(s) licensed with the Colorado Department of Human Services (CDHS) *
License number
Your answer
License capacity
Your answer
Does the institution charge separately for meals? *
How did you hear about CACFP?
Your answer
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