1 1/30/2014
CYFD Web Services
External User Request for EPICS CACFP
Sponsor: Upon completion, e-mail form to CYFDEPICS.CACFP@state.nm.us
*All fields must be completed for processing.
Request Information
(completed by Sponsor)
Date Request Submitted:
Type of Request:
EPICS CACFP access Remove EPICS CACFP access
Modify account info
If modifications, explain:
First Name:
Middle Initial:
Last Name:
Gender: Male Female Date of Birth:
Physical Address:
Email Address:
Sponsor's Name:
Sponsor EPICS ID:
Sponsor's Employee Submitting Request:
Sponsor's Phone:
Sponsor's Email:
Approved user role(s):
(Check all that apply.
See descriptions below.)
CACFP External Home Provider
FP Home Provider Name:
FP Home Provider EPICS ID:
CACFP Facility Sponsor Director
CACFP Home Sponsor Director
CACFP Home Sponsor Monitor QA
(completed by CYFD Program Manager)
CYFD Program Manager: Upon approval, e-mail to SystemAccess@state.nm.us
Approved By:
Date Approved:
***Information Technology Services Use Only***
Date Received:
Processed By:
Date Processed:
389 Directory setup EPICS CACFP setup
Update EPICS CACFP email group
User Login ID:
Date login instructions was sent to Requestor:
2 1/30/2014
The Request Information section of this form is to be completed by the sponsor of the individual
requesting access to EPICS CACFP. The individual requesting access must have an e-mail address
as this is used to send login information to that person and outage notifications. Upon completion,
the form is to be sent to CYFDEPICS.CACFP@state.nm.us for review and approval by the CYFD
Program Manager.
If the user is requesting access to multiple roles, please submit different External Request for
EPICS CACFP forms with distinct e-mail address for each role. Example scenario: User requesting
access to CACFP Home Sponsor Director and Facility Sponsor Director roles.
EPICS CACFP User Roles - Descriptions
CACFP External Home Provider - Licensed or Registered Home Provider on the Food
CACFP Facility Sponsor Director - Food Program Sponsor for Facilities.
CACFP Home Sponsor Director - Food Program Sponsor Director for Home Providers.
CACFP Home Sponsor Monitor QA - Food Program Sponsor Monitor for Home