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You are here: Home / Agreements / SY 2016-17 Agreement Renewal / 2016-2017 SY Annual Agreement Renewal

2016-2017 SY Annual Agreement Renewal

**DEADLINES**

JUNE 1, 2016 - Deadline for SFAs to complete and submit the Free & Reduced School Meals Household Application and Verification forms packet to the State Agency for approval. 

JUNE 8, 2016 - Deadline for SFAs to complete all parts of the agreement renewal with all required hard copy documents received in the State Agency.  *NOTE* Please do not mail documents on June 8th; they must be in the State Agency office by that date.

Online Application (SN Technology System) Instructions

Document Purpose/Description SFA Action/Instructions

Instructions for Completing the Online Application


CLICK HERE  to download.


The Instructions for Completing the Online Application provides step-by-step guidance (with screen shots) to complete the online application to administer one or more of the School Nutrition Programs.

There are three (3) parts to the online application: 

- SFA Application
- Site Application
- Checklist
The Checklist includes a listing of all hard copy documents that must be submitted to the State Agency.
Access the online renewal application at:  https://www.ncchildnutrition.org/
  1. Complete all Site Applications first. 
  2. Make sure to check the two certification boxes at the bottom of each site application page.
  3. Remember:  the Food Safety Inspections must be completed in the online application (see the "Applications" tab).


2016-17 North Carolina Free & Reduced Price School Meals Household Application Template & Verification Forms

Document Description/Purpose SFA Action/Instructions

Free & Reduced School Meals Household Application Template

- App Template (MS Pub)

- App Template (Word)

- App Template (PDF)

F&R Priced Application and Verification Forms Packet 

For NON web-based applications

For Web-based applications

**NEW FILE TYPE**The F&R application editable template was developed in MS Publisher this year to allow more flexibility
in the design.  Should you need assistance please consult with the SFA's IT staff or
Donna Knight.  All other documents were
developed in Microsoft Word.

Prototype documents used for determining student/household eligibility for school meals, notifying households of benefits,
conducting verification, sharing Information,
and notification of Direct Certification.

**IMPORTANT NOTES** 

  • SFAs with year round schools should submit renewal documents and information as soon as possible due to the short turnaround time.
  • Not applicable to SFAs that have implemented Community Eligibility Provision district wide.
  1. SFAs must submit their F&R App and Verification forms to the state agency for approval prior to distribution to households.
  2. Submit the F&R Application on SFA letterhead in the completed state as if it is ready to be distributed to households.
  3. Deadline:  June 1, 2016
  4. All Traditional School Districts, Charter Schools, Non-Public Schools and RCCIs should send your Free and Reduced Priced School Meals Household Application packet to Katie Chatman at chatmankathryn@gmail.com for review and approval.


Written Agreement Documents

Document Description/Purpose SFA Action/Instructions

2016-17 Agreement and Free and Reduced Price Policy Statement

Click on the document to download.

Traditional Public
Trad. Public w/highlights

Charter Schools
Charter w/highlights

RCCI
RCCI w/highlights

NonPublic Schools
NonPublic w/highlights


State Board of Education, North Carolina Department of Public Instruction Agreement to Administer the Federally Funded Child Nutrition Programs (also known as the Annual Written Agreement).

The Agreement outlines the terms between the State Agency (SA) and the LEA/SFA (Local Education Agency/School Food Authority) dictating requirements to administer one or more of the School Nutrition Program (SNP).

The Free and Reduced Price Policy Statement outlines officials designated to make eligibility determinations for the SNP. Furthermore it marks that the LEA/SFA will develop procedures to provide benefits to student.

*NOTES* 

  • This is a checklist item in the Online Application
  • Agreements with highlighted changes are provided for FYI purposes ONLY.  Please DO NOT submit the highlighted version to the State Agency.
ALL SFAs should print and maintain this document on file at the SFA along with the other 2015-16 Agreement Renewal documentation.

Agreement Signature Page

Click on the document to download.

This document is indication by the LEA/SFA that all terms and conditions of the agreement and policy statement will be followed.

*NOTE*

  • This is a checklist item in the Online Application
  • Must be completed by ALL SFAs.
  1. Print THREE Signature pages. 
  2. Obtain the appropriate signatures on each page in BLUE INK.
  3. Submit all THREE (3) signature pagesto the State Agency.   
  • Do not submit copies of signature pages.  EACH page must be signed in blue ink.
  • Required Signature(s): Superintendent, SN Administrator/Director and Finance Officer

Local Wellness Policy Responsibility Document & Signature Page

CLICK HERE to download.

Provides the contact name for the person responsible for the Local Wellness Policy and Outlines the terms that the LEA will develop and execute a plan to promote student wellness in an effort to prevent and reduce childhood obesity as they provide school meals that meet the minimum federal school meal standards.This document must be completed by ALLSFAs.

*NOTE* 

  • This is a checklist item in the Online Application
Print and submit ONE (1)copy with appropriate signature

Required Signature(s): 

  • Traditional:  Superintendent 
  • Charter:  Board Chair     
  • RCCI:  SN Director    
  • NonPublic: SN Director or Supt.

CLICK HERE to download.

Annual confirmation and an indication that all meals provided by the SFA to all students will meet current meal pattern requirements.

*NOTE*

  • This is a checklist item in the Online Application
  • Must be completed by ALL SFAs.
Print and submit TWO (2)copies

Required Signature(s):

  • SFA Administrator

CLICK HERE to download.

Identification by the LEA of the choice for implementing sale and service of competitive foods during the school day.

*NOTE*

  • All SFAs are required to complete this document; however, it is not included as a checklist item in the SN Technology System. 
  • Must be completed by ALL SFAs

Select a Smart Snacks Option and submit ONE (1) copy to the state agency.

Required Signature(s):

  • Traditional - Superintendent
  • Charter - Board Chair
  • RCCI - SN Director
  • NonPublic - SN Director or Superintendent

Community Eligibility Provision (CEP) Agreement Amendment 


CLICK HERE to download..

Agreement amendment between the State Board of Education, North Carolina Department of Public Instruction and the LEA to operate the Community Eligibility Provision (CEP) (only if applicable) – Signature on this document demonstrates the LEA will be compliant with the CEP provision in the participating school(s).

*NOTE* This document is only for SFAs participating in Community Eligibility Provision

Submit TWO (2) hard copies to state agency.

Required Signature(s):

  • Traditional:  Superintendent 
  • Charter:  Board Chair     
  • RCCI:  SN Director    
  • NonPublic: SN Director or Supt.

CLICK HERE to download.

Documents SFA's selected method of establishing the effective date of certification/eligibility for the F&RP School Meals Household Application; Date of Submission or Date of Eligibility
  1. Select the appropriate Option (check box)
  2. Obtain appropriate signature and submit ONE (1) copy


Required Signature(s):
  • SN Administrator


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