Nutrition Education Series Program Request Organization Name* Address* Primary Contact Name* Primary Contact Email Address* Is at least 50% of your audience considered low-income?*YesNoNot SureBriefly describe your organization's work and mission (include types of services and programs offered to clients).In what ways do you think that cooking and nutrition education classes would benefit your clients?How would you rate participating levels for community service programs offered at your facility?Low (0-25%)Moderate (25-75%)High (75%+)We do not currently host any events or enrichment programs.Does your organization have access to a full, working kitchen facility (i.e. stove, sink, refrigerator)?YesNoDoes your organization have access to a classroom area large enough to accommodate 10-15 people?YesNoThe partner agency is responsible for recruiting class participants. What would be your recruitment mehod? (Check all that apply) Flyers Phone Calls Mailings Newsletter Other (please list below) Untitled What day(s) of the week would work best? (Check all that apply) Monday Tuesday Wednesday Thursday Friday What time(s) of day would work best? (Check all that apply) Morning Afternoon Evening Desired Session Length30 minutes1 hour1.5 hours2 hoursOtherDesired Number of Sessions23456+How many times a year are you interested in hosting programming?Number of Expected Participants Target Audience (check all that apply) Children Teens Adults Seniors What program are you interested in hosting? MyPlate Program for Kids Cooking Matters for Adults Cooking Matters for Families Other LanguageEnglishSpanishThird Choice
