"Child and Adult Care Food Program (CACFP) and Summer Food Service Program (Sfsp) Income Eligibility Form - Effective Date Option" - Georgia (United States)

Child and Adult Care Food Program (CACFP) and Summer Food Service Program (Sfsp) Income Eligibility Form - Effective Date Option is a legal document that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States).

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2 Martin Luther King Jr. Drive SE, Suite 754, East Tower, Atlanta, GA 30334
(404) 656-5957
Brian P. Kemp
Amy M. Jacobs
Governor
Commissioner
Child and Adult Care Food Program (CACFP) and Summer Food Service Program (SFSP)
Income Eligibility Form – Effective Date Option
Institution Name:
Delegate Principal/Program Contact:
Institution Address:
City:
State:
Zip Code:
☐ CACFP
Programs(s):
Agreement #:
☐ SFSP
Agreement #:
Effective date option for the institution listed above (select one of the items below):
☐ Signature of parent or guardian
☐ Signature of determining official
Has the institution updated the management plan to reflect the option selected? ☐ Yes ☐ No
Please Note: As a part of this change process, institutions are required to revise their Management Plans to reflect the
option selected to capture the effective date of income eligibility statements. The management plan must be updated prior to
submission of this form. Upon completion of this form, please submit this form via email to your assigned Application
Specialist.
____________________________________________________
_____________________
Signature of Delegated Principal /Program Contact
Date of Submission
DECAL Internal Use Only
Date Received:
Program Official Signature:
Title:
www.decal.ga.gov
2 Martin Luther King Jr. Drive SE, Suite 754, East Tower, Atlanta, GA 30334
(404) 656-5957
Brian P. Kemp
Amy M. Jacobs
Governor
Commissioner
Child and Adult Care Food Program (CACFP) and Summer Food Service Program (SFSP)
Income Eligibility Form – Effective Date Option
Institution Name:
Delegate Principal/Program Contact:
Institution Address:
City:
State:
Zip Code:
☐ CACFP
Programs(s):
Agreement #:
☐ SFSP
Agreement #:
Effective date option for the institution listed above (select one of the items below):
☐ Signature of parent or guardian
☐ Signature of determining official
Has the institution updated the management plan to reflect the option selected? ☐ Yes ☐ No
Please Note: As a part of this change process, institutions are required to revise their Management Plans to reflect the
option selected to capture the effective date of income eligibility statements. The management plan must be updated prior to
submission of this form. Upon completion of this form, please submit this form via email to your assigned Application
Specialist.
____________________________________________________
_____________________
Signature of Delegated Principal /Program Contact
Date of Submission
DECAL Internal Use Only
Date Received:
Program Official Signature:
Title:
www.decal.ga.gov