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Program Renewal

2010-2011 Instructions & Documents
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Please read this IMPORTANT ANNOUNCEMENT about Income eligibility guidelines and Child Nutrition Program renewal documents. Updated June 18, 2010

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Renewal forms that require the sponsor to enter information are available as Microsoft Word forms.  To use a form, first download it to your computer's hard drive as follows:
1 - Right-click on the hyperlink (i.e. bullet).
2 - Select "Save Target As" and specify the location on your hard drive where the file will be saved, then click "Save".
3 - Once you have downloaded the file, open it in Word.  Key information into the gray boxes and print out the form.

PDF Word

Excel


Title/Description
Program Renewal Memo --- --- Program Renewal Memo
Program Renewal Checklist - PDF Program Renewal Checklist - MS Word --- Program Renewal Checklist:  IMPORTANT!  Print, complete and return with any other documents that are mailed to KSDE.
--- --- --- Program Agreement Addendum - There is NO addendum for 2010-2011. The 2008-2009 agreement remains in effect.
KN-CLAIM Quick Ref for Sponsor & Site Application --- --- KN-CLAIM Quick Reference for the Sponsor & Site Applications
KN-CLAIM Quick Ref for Wellness Policy Builder --- --- KN-CLAIM Quick Reference for the Wellness Policy Builder
Program Renewal Instructions --- --- Program Renewal Instructions for Forms 3B through 8M

PLEASE READ CAREFULLY: There are two versions of the Household Application packet (i.e. Letter to Households, Instructions and Application for CNP Benefits):

  • Form 3B does NOT include racial/ethnic data. It should be used by all public school districts and accredited private schools.
  • Form 3C includes racial/ethnic data. It should be used only by non-accredited private schools.

For your convenience, the following formats are provided:

  • (Col. A) PDF format - Print, fill-in-the blanks and distribute.
  • (Col. B) Word enterable for printing - Download, complete variable data on your computer, print and distribute.
  • (Col. C) Word enterable for posting on sponsor's website - Download, complete variable data on your computer, post on your sponsor's website where households can download and complete the application. Then the household could either email or print the completed application. This version is NOT suitable for printing blank copies.

Read the instructions for further information on using the enterable Word forms.

(A) (B) (C)  
Form 3B - Portrait - PDF Form 3B - Enterable for Printing - MS Word Form 3B - Enterable to post on sponsor's website - MS Word Form 3B: Household Application packet without racial/ethnic data
Form 3C - Landscape - PDF Form 3C - Landscape - MS Word --- Form 3C: Household Application packet with racial/ethnic data (landscape orientation)
Form 3D - PDF Form 3D - MS Word --- Form 3D: Letter to Household about Eligibility Determination
Form 3E - PDF Form 3E - MS Word --- Form 3E: Waiver of Confidentiality
Form 3F - PDF Form 3F - MS Word --- Form 3F: Announcement of Child Nutrition Programs
Form 3G - PDF Form 3G - MS Word --- Form 3G: Appointment of New Authorized Representative
Form 3J - PDF Foirm 3J - MS Word --- Form 3J: Special Milk - Information for Households with Pre-K and Kindergarten Students (for sponsors providing both school meals AND the Special Milk Program with paid and free milk)
Form 7A - PDF Form 7A - MS Word --- Form 7A: Letter to Household about Direct Certification
Form 8D - PDF Form 8D - MS Word --- Form 8D: Letter to Household about Selection for Verification
Form 8M - PDF Form 8M - MS Word --- Form 8M: Letter to Household about Benefit Decrease
At-Risk Application - PDF --- --- Optional Application for State At-Risk Funds & Instructions
--- Prototype Agreement for Food Service - MS Word --- Food Service Contract between USD and Private School
New Site Application - PDF New Site Application - MS Word --- New Site Application

Guidance
      Title/Description
Guidelines for Determining Eligibility - PDF --- --- Guidelines for Determining Eligibility
Income Eligibility Guidelines - PDF --- --- Income Eligibility Guidelines Chart
Confidentiality Instructions - PDF --- --- Instructions Regarding Confidentiality of Reduced Price/Free Eligibility Information
--- --- --- Foreign Language Materials Information
Snack Program Q&A - PDF --- --- After School Care Snack Program, Questions & Answers
Special Asistance Alternatives - PDF --- --- Special Assistance Alternatives (i.e. Provisions 1, 2 and 3)
--- ---

Annual Financial Report - Excel

Annual Financial Report - These forms can be used as worksheets prior to entering the data online in KN-CLAIM (due by August 15).  Complete the monthly financial worksheets and the annual totals will be automatically computed.
Annual Financial Report - Public School Instructions - PDF --- --- Annual Financial Report Instructions for Public Schools
Annual Financial Report - Private School Instructions - PDF --- --- Annual Financial Report Instructions for Private Schools, RCCIs and State-Operated Schools

Keep a copy of all program renewal documents for your files.

Signed documents must contain ORIGINAL signatures.

All program documents are due by July 15, 2010 to:
Child Nutrition & Wellness, Kansas State Department of Education,
120 SE 10th Ave., Topeka, KS 66612-1182.
Questions? Call (785) 296-2276.

 

 
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