NORTH CAROLINA CACFP
2022 "And Justice for All"
Poster Request Form

THIS POSTER REQUEST FORM IS FOR NORTH CAROLINA CACFP INSTITUTIONS ONLY. Institutions outside of NC should contact their State agency for poster requests.

The USDA updated the "And Justice For All" Civil Rights poster in May 2022. Complete this form to let the State agency know how many new posters your institution needs. The 2022 "And Justice For All" poster must be prominently displayed at all CACFP participating facilities.

For questions regarding this form or the "And Justice For All" posters,
please contact us at: CACFPagreement@dhhs.nc.gov

First Name *

Last Name *

Title *

CACFP Agreement Number (ex. 1234) *

Institution Name *

Please select one: *

Sponsoring Organization

Independent Center

Shipping Address / This is where we will mail your requested posters. (ex: 999 Sarah Lane): *

City *

State *

Zip *

Institution Phone Number (include area code): *

Institution Email Address / This email address will be used to send your confirmation. *

Number of "And Justice For All" posters requested (Please request as many as needed for ALL facilities): *

CERTIFICATION

I have requested the necessary number of "And Justice For All" posters to ensure that it can be properly displayed at each facility per CACFP regulations. I understand that the 2022 "And Justice For All" poster must be on display at each facility by September 30, 2023. *

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NORTH CAROLINA CACFP 2022 "And Justice for All"Poster Request Form

For questions regarding this form or the "And Justice For All" posters, please contact us at: CACFPagreement@dhhs.nc.gov

CERTIFICATION

Save & Return

NORTH CAROLINA CACFP
2022 "And Justice for All"
Poster Request Form

For questions regarding this form or the "And Justice For All" posters,
please contact us at: CACFPagreement@dhhs.nc.gov