Program Name: # of Students Estimated to Eat:
Program Coordinator Name:
Phone: Email:
Area Coordinator Name:
Phone: Email:
Requested Meal Time: Days Needed: Monday Tuesday
Program Start Date: Wednesday Thursday
Program End Date: Friday
In order to qualify for this feeding program, the school must qualify based on Texas
Department of Agriculture (TDA) qualifiers that may differ each school year. AISD Food
Services will determine eligibility upon receiving the completed application and will
notify the Program Coordinator.
Students receiving meals must be participating in an after-school program which must
include an educational or enrichment component. Only program participants (students)
may consume the meals.
The accountability options outlined below must be followed or the program will
immediately forfeit eligibility to receive after-school meals.
Request an Accountability Option: (Check One)
Hot Plated Meals Cafeteria staff will handle accountability.
Students will come through the cafeteria serving line to pick up a hot plated meal and enter
their student ID number at the register. Students who choose to take a meal MUST take at least
three components (food groups) of the meal.
Cafeteria staff will handle accountability.
Fast and Fresh (Cold) Bento Box Meals Program staff will handle accountability.
This option offers flexibility on when meals can be served, though meals must be eaten on
campus before the students leave for the day. Meal timing is at the program coordinator’s
discretion. This meal option is a “Grab and Go” meal service style and the meals may be eaten
anywhere on campus.
The after-school program will assume all responsibility for meal distribution and tracking
according to the federal guidelines of the Child and Adult Care Feeding Program. Rosters will be
provided by Cafeteria Managers. The after-school program will be responsible for submitting
the roster to the Cafeteria Manager by 10 a.m. the following day.
Completion of an accountability training course is mandatory.
Person(s) administering the meals must complete the online Civil Rights training and attach a
completed Civil Rights Certification to this application. See instructions below.
Person Responsible: Phone:
I understand and accept my after-school meal responsibilities in operation of the federal Child
and Adult Care Feeding Program (CACFP). I understand that meal participation will be audited
throughout the duration of the program and I may periodically be asked to provide attendance
records to verify students’ eligibility to participate. I will abide by the requirements above or
program eligibility will be forfeited.
Program Coordinator Signature: __________________________________ Date: ___________
Campus Principal Signature: _____________________________________ Date: ___________
FS Area Supervisor Signature: ____________________________________ Date: ___________
FS Assistant Director Signature: __________________________________ Date: ___________
Questions? Please contact your Cafeteria Manager or AISD Nutrition and Food Services at
AISD Child and Adult Care Feeding Program (CACFP) After-School Meals Application 2
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Child and Adult Care Feeding Program (CACFP)
Grab and Go After School Meal Service
Civil Rights Training Information
o Read and work through the Civil Rights training linked below:
o Civil Rights Training English
o Civil Rights Training Spanish
o Take the assessment quiz.
o When you have successfully completed the quiz, please fill out the quiz form
o NAME: Your name
o Contracting Entity: Austin ISD
o CS Identification Number: 01068
o Email Address: Your email address
o Date: Today’s Date
o The confirmation sheet will be emailed immediately to the email you provided. Save
the confirmation to your computer, or print a copy, and attach with the completed
o All applications and training documentation may be submitted in-person or
electronically to the Cafeteria Manager. Electronic submissions will be sent to the
Cafeteria Manager’s email address.
AISD Child and Adult Care Feeding Program (CACFP) After-School Meals Application 3