"Meal Count Worksheet for Camps" - Connecticut

Meal Count Worksheet for Camps is a legal document that was released by the Connecticut State Department of Education - a government authority operating within Connecticut.

Form Details:

  • Released on February 1, 2018;
  • The latest edition currently provided by the Connecticut State Department of Education;
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Download "Meal Count Worksheet for Camps" - Connecticut

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Summer Food Service Program (SFSP)
MEAL COUNT WORKSHEET FOR CAMPS
Date
Camper’s Name
Meals
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Total Eligible Meals:
Total Ineligible Meals:
Total Program Adult Meals:
Total Non-Program Adult Meals:
Site Supervisor/Designee Signature:
Date
:
Connecticut State Department of Education  Revised February 2018  Page 1 of 2
Summer Food Service Program (SFSP)
MEAL COUNT WORKSHEET FOR CAMPS
Date
Camper’s Name
Meals
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
B
L
S
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Total Eligible Meals:
Total Ineligible Meals:
Total Program Adult Meals:
Total Non-Program Adult Meals:
Site Supervisor/Designee Signature:
Date
:
Connecticut State Department of Education  Revised February 2018  Page 1 of 2
SFSP MEAL COUNT WORKSHEET FOR CAMPS, continued
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its
Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on
race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or
funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American
Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have
speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made
available in languages other than English.
To file a program complaint of discrimination, complete the
USDA Program Discrimination Complaint
Form, (AD-3027) found online at:
http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of
the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to
USDA by:
(1) mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442;
(3) email: program.intake@usda.gov.
This institution is an equal opportunity provider.
For more information on the SFSP, visit the Connecticut State Department of Education’s
SFSP
website.
This form is available at
http://portal.ct.gov/-/media/SDE/Nutrition/SFSP/MealCountCampSFSP.pdf.
Connecticut State Department of Education  Revised February 2018  Page 2 of 2
Page of 2