Program Forms

• Income application forms
  
  
• Child enrollment forms
  
  
• Menu/meal count forms

Income Application Forms

Application for tier 1 rates and to claim your own children
This application is used for child care providers who do not live in a tier 1 eligible area and desire to apply for tier 1 rates based upon eligibility criteria. An approved application authorizes a child care provider to receive tier 1 rates for day care children and to claim eligible residential children when served meals/snacks at the same time as the day care children. This application requires verification of all benefit or income information.

Application to claim your own children
This application is used for child care providers that reside in a tier 1 eligible area and desire to apply to claim residential children. An approved application authorizes a child care provider to receive tier 1 rates for eligible residential children when served meals/snacks at the same time as the day care children. This application doesn’t require verification of benefit or income information.

Application for parents/legal guardians to apply for tier 1 rates
Child care providers that are not eligible to receive tier 1 rates have the option to ask the parents/legal guardians of their day care children to apply for tier 1 rates. This application is to be completed by the parents/legal guardians of day care children. An approved application authorizes the meals/snacks to be reimbursed at tier 1 rates for the eligible children on the application. Some benefits under section 1 on the application require verification.

Application for child care providers to claim foster child(ren)
A child care provider that has a foster child residing in the day care home is often eligible to claim the foster child however an application is necessary when the child care provider is not approved to claim residential children. An approved application authorizes meals/snacks to be reimbursed at tier 1 rates for the eligible children on the application when meals/snacks are served at the same time as the day care children.

Child Enrollment Forms

A child enrollment form is used to enroll children in the FoodCare program. Child enrollment forms provide verification of attendance and meals to be served when present in a day care. The information is necessary for validation of claimed meals and snacks on a meal claim.

There are two types of child enrollment forms, one for infants (0-11 months) and one for children ages 12 months and older. A Building for the Future/WIC Flyer must accompany each child enrollment form.

Click here for an infant participation form (0-11 months)

Click here for a child enrollment form (12 months and older)

The legal guardian (or foster parent in cases of foster children) must complete the parent section of the child enrollment forms. The child care provider must complete the lower section of the child enrollment forms. Child enrollment forms must be on record in the NDC office for all children eligible for the food program in a day care.

Menu/Meal Count Forms

The USDA requires a menu for each meal and snack that are claimed for day care children. NDC supplies menu forms for recording daily menus and meal counts at no charge. There are two menu forms available. One form is used for children ages 12 months and up, and the other form is for infants 0 through 11 months of age.

Click here for the menu/meal count form

Click here for the infant menu form

If a child care provider would like to use alternative menu/meal count forms such as one available through a web based record keeping system, the NDC office should be contacted to determine how program regulations can be met.

Top of Page