Required Entity Organization Application Forms

Forms for Prospective School Nutrition Program Operators

• ADEConnect Entity Administrator Form (if applicable)
• State of Arizona W-9 Form
• Nonprofit 501c3 from the IRS (if applicable)
• Add/Change/Delete Form (ACD)
  • Manual Form (print, sign, scan and email)
  • Electronic Form (access and fill out online, electronic signature)
    • The “Applicable Program” at the top of the form MUST be selected in order for the request to be processed.
    • The initiator of the form must also be an authorized signer.
• Arizona Department of Health Services License (if applicable)
• Unique Entity Identifier (UEI) lookup or request a UEI by visiting https://sam.gov/content/duns-uei
• Food Program Permanent Service Agreement Initiation Form
• Certification Regarding Debarment
• Certification Regarding Lobbying
• Free and Reduced-Price Policy Statement
  • If applicable to your operation, please also include:
    • SFA At-Risk Afterschool Meals Responsible Principals Addendum
    • Addendum- Provision 2
    • Addendum- Provision 3
    • Addendum- Community Eligibility Provision (CEP)
    • Addendum- Non-Pricing
    • Addendum- RCCI without Day Students
    • Addendum – Special Milk Pricing
• Civil Rights Pre-Award Compliance Form
• Media Release
• Food Service Vendor Contract (if applicable)
  • Inter-Agency Agreement (Checklist) (Template)
  • Informal Catering Contract Agreement (Checklist) (Template) 

 Forms for Prospective Child and Adult Care Food Program Operators

• ADEConnect Entity Administrator Form (if applicable)
• State of Arizona W-9 Form
• Nonprofit 501c3 from the IRS (if applicable)
• Add/Change/Delete Form (ACD)
  • Manual Form (print, sign, scan and email)
  • Electronic Form (access and fill out online, electronic signature)
    • The “Applicable Program” at the top of the form MUST be selected in order for the request to be processed.
    • The initiator of the form must also be an authorized signer.
• Arizona Department of Health Services License (if applicable)
• Child Care Standards for Unlicensed Facilities (if applicable - only required for unlicensed sites/facilities)
• Initiation Form For Electronic Child and Adult Care Food Program Permanent Service Agreement
• Three Months of the Most Recent Bank Statements
• 4-Week Cycle Menu

Additional Forms Required for At-Risk Only:

• Detail of Enrichment Activity (if applicable)
• Documentation of Site Eligibility (if applicable)
• Non-Associated Site Agreement (if applicable)