Nutrition Education Grocery Story Tour Request Organization Name* Address* Primary Contact Name* Primary Contact Phone Number* Is at least 50% of your audience considered to be low-income?*YesNoNot SureRequested Date Requested Time If the event is not yet scheduled, please indicate the day(s) of the week that would work best. (Check all that apply) Monday Tuesday Wednesday Thursday Friday If the event is not scheduled, please indicate the time(s) of day that would work best. (Check all that apply) Morning Afternoon Evening Number of Participants Expected Suggested Grocery Story Name and Address Language English Spanish
