West Virginia Department of Education
Charleston, West Virginia 25305
Daily Records of Program Operations
Name of Site______________________________________________
Child and Adult Care Food Program
Month___________________________
Sponsor_____________________________________________________
Year____________________________
DATE
Free
Breakfasts
Red.
Paid
1
2
Type: CHILD
Total
Free
NUMBER OF MEALS SERVED TO CHILDREN/DAY CARE ADULTS
Lunches
Suppers
Red.
Paid
Total
Free
Red.
Paid
Total
Between Meal Suppl. (Snacks)
Free
Red.
Paid
Total
Break
5
6
13
17
PROGRAM ADULTS
Adult Meals
Lunch
Supper
ADULT
(CIRCLE ONE)
NON-PROGRAM MEALS SERVED
Snack
Break
Lunch
20
21
22
Supper
AT-RISK
Snack
Snacks
24
25
TOTALS
WVDE-ADM-54 2002
3
4
7
8
9
10
11
12
14
15
16
18
19
23
ITEM
1. FUNDS RECEIVED DURING MONTH
TOTALS
A. Participant’s Payments for Meals
B. Department of Education
1. Cash in Lieu of Commodities
2. Reimbursement – Meal
C. Non-Program Adult Program
D. Other
2. TOTAL FOOD SERVICE INCOME
CASH EXPENDITURES
DATE
BILL
PAID
CK. #
Name of Payee or Vendor
Food
Labor
Adm.
Costs
(A)
(B)
(C)
Equip.
(D)
Other
(Supplies)
Repairs Etc.
Loan
Payment
Other
TOTAL
(E)
(F)
(G)
UNPAID BILLS
Company
WVDE-ADM-54
2002
Amount
Company
Amount