HomeMy WebLinkAboutUser Authorization FormFLORIDA DEPARTMENT OF EDUCATION
SCHOOL BUSINESS SERVICES
FOOD AND NUTRITION MANAGEMENT
CNP Florida Signer/User Authorization Form
Sponsor Name
County/District
E-mail Address
Telephone Number
City of Miami Parks & Rec.
Dade_County
gkitchen@ci.miami.fl.us
(305)416-1308
Food Service Management Company (TSMC):
Program Representative:
(Please note: Food Service Management Company (FSMC) employees are not permitted access to the CNP Florida system.)
Please type or print the names and titles of employees/administrators authorized to electronically submit Applications or Monthly Claims for Reimbursement
associated with participation in the federal Child Nutrition Programs. If you have a contract with a FSMC, please list above.
Name and Title of
Please list
Security Action
Authorized
Applications
Claims
Employee/Administrator
ALL
to DELETE
Finance
Add
Modify
�'
Suspend
p
NSLP
SFSP
S MP
NSLP
SFSP
SMP
(Please Type or Print Clearly)
Agreement
Numbers
users from
the system
ESE003
Access
SSOP
SSOP
Name: Gwendolyn Kitchen
04-0899
Title: -Assistant
Superintendent
X
X
X
E -Mail: kitchen@ci . Miami. f 1
us
Name:
Jose Matas
04-0899
Title: Principal Staff Analyt
X
X
X
E -Mail: @ c i. m i a m i f l u
Name:
Title:
E -Mail:
I hereby authorize the above users to submit information on behalf of the sponsor noted above. Information submitted is true and correct and provided in connection with the receipt of Federal funds.
DELETE USER Access should be assigned very carefully. It is the responsibility of the Food Service Director or their Assigned Delegate.
Type or Print Name of Chief Administrative Officer
Signature of Chief Administrative Officer
Title of Chief Administrative Officer
Date Signed
Fax AND Mail to: (850) 245-9276 or Florida Department of Education, Food and Nutrition Management, 325 W. Gaines Street, Suite 1024, Tallahassee, FL 32399-0400
Adm001 12/15/08