Empower Success/Progress Story

Name of Facility:

Phone Number:

Email Address:

City:

	Type of facility	How many 0-5 year old children do you serve	How many 6+ year old children do you serve?	Does your facility participate in the Child and Adult Care Food Program (CACFP)?
Please answer the following questions	Please answer the following questions Type of facility menu	Please answer the following questions How many 0-5 year old children do you serve menu	Please answer the following questions How many 6+ year old children do you serve? menu	Please answer the following questions Does your facility participate in the Child and Adult Care Food Program (CACFP)? menu