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Ohio Healthy Programs
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We Want To Hear From YOU!
Name of Program: (Required)
Contact Person: (Required)
Program address: (Required)
City: (Required)
State: (Required)
ZIP: (Required)
County (Required)
Program Phone: (Required)
Program Email: (Required)
Program License Type:
Current ODJFS License
Current ODE License
Provisional ODJFS License
Do you have more than one location?
Yes
No
If Yes, how many locations?
Which meals does your program serve?
breakfast
am snack
lunch
pm snack
dinner
evening snack
Has your program participated in the Child and Adult Care Food Program before? (Required)
Has your program participated in the Child and Adult Care Food Program before? (Required)
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yes
no
Are you or your program listed on the National Disqualified List (NDL)? (Required)
Are you or your program listed on the National Disqualified List (NDL)? (Required)
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yes
no
How many children are enrolled at your program? (Required)
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What percentage of your enrollment is subsidized? (Required)
How many years experience do you or program director have? (Required)
Is your program vended? (Required)
Is your program vended? (Required)
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yes
no
Is your program for-profit? (Required)
Is your program for-profit? (Required)
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yes
no
Does your program have access to the internet? (Required)
Does your program have access to the internet? (Required)
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yes
no
If your program has a website, please enter the address here: (Required)