Cornerstone Family Ministries CCFP Sponsored Center Enrollment Application - Screening
Center Physical Address *
Center Physical Address
City
State/Province
Zip/Postal
Country
Point of Contact Responsible for On-Site Daily Food Operations

Do you have Shareholders or a Board of Directors? *
What type of Center are you operating? Select only one type. *
If non-profit, upload current 501(c)(3) Tax Exempt Status Certificate
Maximum upload size: 104.86MB
Upload Statement of Authority if non-profit is utilizing the 501 (c) 3 of a parent organization.
Maximum upload size: 104.86MB
If not licensed (Religious-exempt) submit copy of Religious Exempt Accreditation Certificate
Maximum upload size: 104.86MB
If not licensed (Religious-exempt) submit copies oFire Marshal Inspection Report/Permit
Maximum upload size: 104.86MB
If not licensed (Religious-exempt) submit copies of Occupancy Permit
Maximum upload size: 104.86MB
Do you currently provide meals to your children? *
If so, do you charge for meals served?
Do you currently participate in the CCFP program? *
Have you ever been on the CCFP Program? *
Was it filed directly with state or under sponsorship?
Does center accept all children regardless of race, color, age, sex, disability and national origin? *
Number of children by Ethnicity:

Number of children by Race:
Does center receive any Head Start or Early Head Start Funding? *
Type of licensing, choose 1 only.
I understand that Cornerstone Family Ministries is a Sponsor of the Child Care Food Program (CCFP) through the Florida Department of Health (state agency). While Cornerstone Family Ministries sponsorship of the program is designed to help centers like mine to benefit from the program without the liability of a direct contract with the State, I do understand that I can choose to apply directly with the state agency and incur that liability on my own. *