NORTH CAROLINA CACFP "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. Complete this form to let the State agency know how many new posters your institution needs. The "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: CACFPtraining@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): *

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. If I have requested 0 (zero) posters, I certify that my Institution has ordered or received the updated posters from another source. (Please type your first and last name in the box below to sign this form.) *