Join the Program

If you are interested in learning more about the Food Program. Please fill in this quick formand submit it to us. We will contact you with more information soon! (*indicates a required field)

First Name* Last Name*

Address*

City* State* Zip Code*

Phone Number Email Address

-Please note that we work with providers who are located in the Wasatch Front area only. From Ogden south to Springville, including Tooele. If you do not live in this area, fill out the form anyway, and we will try to find a sponsoring organization that serves your area.-

In order for us to better help you we need a little information:

1. Are you currently providing day care services in your home, or do you plan on providing day care in the near future

Yes

2. Have you ever participated in the Food Program before? (in or out of state)

Yes

**If yes, write the name of the sponsor and the last date you made a claim:
Sponsor: Last date claimed

3. Do you currently have a Family Home Day Care License or a Residential Certificate?

Yes

No**

**If no, and you plan on providing care in your home, please contact the Utah Dept. of Health, Child Care Licensing Division at 1-888-287-3704 for a license or certificate application. You must have a current license/certificate to participate on the Food Program.

You may begin receiving reimbursement for the meals you serve your day care children once you have a license or certificate in place and have had a home visit by one of our field monitors.

Please enter any comments or questions, we will do our best to answer them.

Upon submitting this form, you agree to be contacted by an employee of Helping Hands, Inc.

In accordance with federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington D.C. 20250-9410 or call (800) 795-3272 (voice) (202) 720-6382 (TTY). USDA is an equal opportunity provider & employer.

De acuerdo a lo establecido por las leyes Federales y el Departamento de Agricultura de los EE. UU. (USDA, siglas en ingles), se prohíbe a este organismo la discriminación por raza, color, origen nacional, sexo, edad, o impedimentos de las personas. Para presentar una queja de discriminación escriba a: USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington D.C. 20250--9410 o llame (800) 795-3272 (voz) (202) 720-6382 (TTY). USDA es un proveedor que ofrecer oportunidad igual a todos.

The above information is for internal use only. We will never sell, share, or make your personal information available to any entity outside of Helping Hands without your express permission.