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CALIFORNIA DEPARTMENT OF EDUCATION <br />NUTRITION SERVICES DIVISION <br />SUMMER FOOD SERVICE PROGRAM <br />INTRODUCTION CHECKLIST <br />AGENCY NAME: <br />SUMMER FOOD SERVICE PROGRAM <br />(REV. 1/2010) <br />CDE USE ONLY <br />VENDOR #: <br />CNIPS #: <br />Thank you for your interest in being a Summer Food Service Program Sponsor. As a sponsor, your <br />application approvals and reimbursement claims for this program will be easily processed online <br />through our Child Nutrition Information and Payment System (CNIPS). To obtain a CNIPS User ID and <br />Paccwnrri _ nlPasP nmvide the following information at least 45 days before your proposed start date. <br />AGENCY USE <br />CDE USE <br />All agencies - please provide the following information. <br />1. Official Agency Certification (Mail the <br />❑ <br />❑ <br />original) <br />2. Agreement to Participate <br />❑ <br />❑ <br />Submit all 9 pages (Mail the original) <br />Private nonprofit agencies - In addition to the above documents private nonprofit agencies must also <br />provide the following information. <br />3. Organization chart — include names and <br />❑ <br />❑ <br />addresses of board members. <br />4. Financial Profit and Loss Statement <br />❑ <br />❑ <br />Last year's statement from an outside source <br />5. Payee Data Record (STD. 204) <br />❑ <br />❑ <br />Private non-profit agencies only (Mail the <br />original) <br />6. Internal Revenue Service (501)(c)(3) <br />❑ <br />❑ <br />tax-exempt letter — must reflect your <br />agency's current name and address. <br />Please mail all original signed documents to: <br />California Department of Education <br />Nutrition Services Division — Attn: Donna Chamberlin <br />1430 N Street, Suite 1500 <br />Sacramento, CA 95814 <br />