Child and Adult Care Food Program

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Child and Adult Care Food Program (CACFP) Fluid Milk Substitution Request Form

Required Nutrients Required Amounts Per Cup %DV Per Cup or %DV in Substitute product
Calcium 276 mg 28%
Protein 8 g 16%
Vitamin A 500 IU 10%
Vitamin D 100 IU 25%
Magnesium 24 mg 6%
Phosphorus 222 mg 22%
Potassium 349 mg 10%
Riboflavin 0.44 mg 26%
Vitamin B-12 1.1 mcg 18%
I choose to provide the substitute product to my provider. By providing a creditable milk substitute, I understand that the provider may receive meal reimbursement for the meal/snack served.
I choose to not provide the substitute requested. I understand the provider is not required, but has the discretion to, purchase and provide fluid milk substitutions as requested.