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Child and Adult Care Food Program INCOME ELIGIBILITY CATEGORIES SUMMARY Center/Site Name Names of Enrolled Participants Income Form Date Month/Year Attended A Meal Income Categories Free RP Paid Comments Totals 12/2016 Child Nutrition Wellness Kansas State Dept. Of Education Form 12-C INSTRUCTIONS Income Eligibility Categories Summary The Income Eligibility Categories Summary lists the name of each enrolled meal participant for the site and the participant s income category. After completing...
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