Utah State Board of Education

CNPweb Access Form

Instructions: The CNPweb Access Form is used to request active user and to inactivate a user. Please complete the form below. The form is to be submitted to Utah State Board of Education-Child Nutrition Program(USBE-CNP) 10 days prior to requested activation/deactivation time. Once approved, you will be contacted by phone or email. Email: Fax: 801-538-7883

For assistance or questions, contact USBE Child Nutrition Programs at 801-538-7680.

Institution Name:Click or tap here to enter text.

Agreement Number: Click or tap here to enter text.

Request to:
☐Activate
☐ Inactivate / Access Allowed for following Program(s):
☐Child and Adult Care Program (CACFP, At-Risk Snack/Supper, FDCH, Adult)
☐School Nutrition Programs(NSBP, NSLP, ASSP, SSO, SMP)
☐Food Distribution Program
☐Summer Food Service Program
I attest that I haveadministrative and financial responsibility authorization for program operation. I understand and agree to the following:
  • I am responsible for my password and all information entered into CNPweb.
  • I am liable for anyone that uses my username and password to submit information on CNPweb.
  • Upon closing, selling or quitting I will notify the Child Nutrition Programs immediately.
I understand that violation for the above provisions may result in a Serious Deficiency and may jeopardize my current and future participation in the Child Nutrition Programs.
First name:
Click or tap here to enter text. / Middle initial:
Click or tap here to enter text. / Last name:
Click or tap here to enter text. / Date:
Click or tap here to enter text.
Signature: / Title: Click or tap here to enter text.
Email Address: Click or tap here to enter text. / Phone Number(ext.):Click or tap here to enter text.

*This box is to be completed by owner, board member, or other authorized representative recognized by our office.

The USBE must be notified if a CNPweb authorized user leaves employment in order to revoke authorization.

Please indicate under each form the type of access an individual will be allowed:

•Blocked – no access

•Read only – may view information, but cannot make changes

•Edit – may enter and make changes

User 1:

Full Name / Title / Work Email Address / Work Phone Number (ext.)
Click or tap here to enter text. / Click or tap here to enter text. / Click or tap here to enter text. / Click or tap here to enter text. /
Applications / Claims / Family Day Care Homes Budget / Remove User
☐Blocked
☐Read Only
☐Edit / ☐Blocked
☐Read Only
☐Edit / ☐Blocked
☐Read Only
☐Edit / ☐Remove
I understand and agree to the following:
•I am responsible for my password and all information entered into CNPweb.
• I am liable for anyone that uses my password to submit information on CNPweb.
Signature: Date:

User 2:

Full Name / Title / Work Email Address / Work Phone Number (ext.)
Applications / Claims / Family Day Care Homes Budget / Remove User
☐Blocked
☐Read Only
☐Edit / ☐Blocked
☐Read Only
☐Edit / ☐Blocked
☐Read Only
☐Edit / ☐Remove
I understand and agree to the following:
• I am responsible for my password and all information entered into CNPweb.
• I am liable for anyone that uses my password to submit information on CNPweb.
Signature: Date:

*If you need to make changes to additional users, attach another sheet of paper.

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