Youth Educational Services, Inc

							                 Youth Educational Services, Inc
                       2321 Main Street, Tucker, GA 30084
                       P:(770) 938-3188 F: (770) 938-6869




Day Care
Month/Year

   Enrollment Roster
 (Please write on a blank Roster form, the names, DOB, date of entry for
         any new enrollee /Date of Exit for any children exiting)


   Income Eligibility Statements
 (An IES/Enrollment Forms must be submitted for all enrolled participants)

    A Copy of Title XX Invoice from DFACS/CAPS (If Applicable) or
Title XIX (Medicaid or Medicare (For Adult Care Centers)


  Daily Menu and Food Service Records Form
      (1 form for each day of service)

  Point of Service Form

  Daily Attendance Form
  (Must have Daily Totals)


   NON-Profit CACFP Food Program Forms
        Operating Cost Form
        Time Sheets
        Time Distribution Report

     **Please attach COPIES of your monthly Food/Supply receipts**
      NOTE: Please HIGHLIGHT ALL milk purchases on the copy of the receipts

   Copy of Centers Monthly Menu
 *PLEASE! MAKE A COPY OF YOUR CLAIM BEFORE SUBMITTING*