Wisconsin Department of Public Instruction
Child And Adult Care Food Program FFY  Application
Annual Certification

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Validation Error:- You must correct the following error(s) before proceeding:
  • First Name is required.
  • Last Name is required.
  • Phone Number Area Code is required.
  • Phone Number City Code is required.
  • Phone Number is required.
  • Email is required.

 
Your agency must open the following online pages by clicking on the links at the bottom of the screen:
All Institutions
  • Budget - Review and revise (if applicable) for the upcoming federal fiscal year.
  • Program Upload(s) - No changes needed unless your Agency is a Pricing Program.
Sponsoring Organizations Only:
  • Training and Monitoring - Open and complete the training and monitoring information.
  • Controls D - Open, review and update previously uploaded document(s) or upload any new document(s) that may apply to your agency.
This is to certify that   -   meets all of the requirements for renewing institutions contained in 7CFR 226.6(b)(2): This means   -   certifies that:

For all institutions (Sponsoring Organizations and Independent centers) :
  • The institution and its principals are not currently on the National disqualified list;
  • A list of any publicly funded programs that the sponsoring organization and its principals have participated in, in the past 7 years, is current;
  • The institution and its principals have not been determined ineligible for any other publicly funded programs due to violation of that program's requirements, in the past 7 years;
  • No principals have been convicted of any activity that occurred during the past 7 years and that indicated a lack of business integrity;
  • The names, mailing addresses, and dates of birth of all current principals have been submitted to the State agency;
  • The institution is currently compliant with the required performance standards of financial viability and management, administrative capability, and program accountability; and
  • Licensing or approval status of each child care center or adult day care center is up-to-date.

For Sponsoring Organizations only:
  • The management plan on file with the State agency is complete and up to date;
  • No sponsored facility or principal of a sponsored facility is currently on the National disqualified list;
  • The outside employment policy most recently submitted to the State agency remains current and in effect.
  • The list of the sponsoring organization's facilities on file with the State agency is up-to-date; and
  • All facilities under the sponsoring organization's oversight have adhered to Program training requirements

Any of the above information that has changed since the initial contract has already been submitted to the State Agency or is being submitted with this certification.

Sponsor Info Estimated Enrollment Records Boards/Corporate Officials For Profit Board Additional Gov Board Members
Boards Info Controls-A Controls-B Staff Training* Controls-C*
Budget Controls-D* Site(s) List Program Upload(s)

 
Certification for U.S. Department of Agriculture (USDA) Child Nutrition Programs
  • I certify that all the information within this contract is true and correct to the best of my knowledge and that the applicant herein named is in compliance with the audit requirements stated in 2 CFR Part 200.
  • I understand that this information is being given in connection with the receipt of federal funds and that deliberate misrepresentation or withholding of information may subject me to prosecution under applicable State and Federal criminal statutes.
  • I agree to abide by the terms and conditions of the Contract and Permanent Agreement and Policy Statement.
Click here to view the CACFP Permanent Agreement and Policy Statement

I agree to certification  
Please fill in all requested information. It will be used to contact the agency for any
questions regarding the submitted Application.
 
First Name Last Name
Phone Number Extension
Email