CACFP New Sponsor Inquiry

Fill out the following form and click Submit.
The * indicates a required field.

Please fill in all required fields and click submit again.

Sponsor

UEI #: *

If you do not have a UEI # or need further information please go to https://sam.gov

Sponsor Name: *

As it appear in tax statements

Address Line 1: *

Address Line 2:

City: *

Please provide a valid city.

State: *

Zipcode: *

County: *

Phone: *

Cell:

Fax:

Sponsor Entity Type: *

FEIN Number: *

Eligibility: *

Public Entity

Not-For-Profit, (IRS) Federal Tax-Exempt conforming to the original ruling from the Internal Revenue Service (IRS)

Private For-Profit

Corporation

Sole Proprietorship

Contact

First Name: *

Middle Name:

Last Name: *

Title: *

Phone: *

Cell:

Fax:

Email: *

Birthdate: *

Organization Type

Select the organization type that best describes your organization.

State or Local Government

Educational Institution

Non-Profit Organization (Secular, non-religious)

Non-Profit Organization (Faith-based, associated with a place of worship or certain religion)

Other

Multi-State Organizations

Does your organization operate the Child and Adult Care Food Program in other states? *

Yes

No

Audit Information

During this calendar year, what is the end date of your organization’s fiscal year? *

For Profits (initial) *
I agree to allow the Illinois State Board of Education auditing staff or its contractors the conduct program specific audits for this for-profit organization.

Will your organization expend $500,000 or more in federal funds during your organization’s established fiscal year? (Not applicable for Private For-Profit institutions.) *

Yes

No

Do you agree to send this agency a copy of your organization’s A-133 single audit, program specific audit or appropriate written documents as specified in OMB Circular A-133 within 30 days after receipt of auditor’s report or within nine months of the end of the fiscal year, whichever is earlier? (Not applicable for Public Entities and private For-Profit institutions.) *

Yes

No

Do you agree to submit a copy of the A-133 Audit to the federal Audit Clearinghouse? (Not applicable for Public Entities and private For-Profit institutions.) *

Yes

No

Programs

Indicate or list publicly funded programs your institution has (and key individuals who have) participated in during the past seven years. *

Illinois State Board of Education – Child and Adult Care Food Program or other funding

Illinois Department of Human Services – Subsidized Child Care benefits, Head Start or other funding

Department of Children and family Services – Protective Care or other funding

Other

Submission

By clicking the Submit button, you certify that all information presented in this form is true and correct to the best of your knowledge.