Help Us Help You

Which Best Describes You?
Parent School/University Other
Student Government/Health Department
Individual Business
Contact Information
Name First Last
Email
Street Address
City  Zip  State
Phone
Type of Program
School
Salad Bar
Fruit & Veggie Program
Fruit & Vegetable Vending
Wellness Policy
Schools Other
Business
Fruit & Veggie Store Events
Contests
Promotions
Business Other
Farmers' Markets
Program Description
Describe your program in 200 words or less:

Program Name (e.g. Farmer's Market, School Veggie Party)
Select all that describe your program:
Interactive
Food preparation demonstrations
Fruit/vegetables available to eat
Educational entertainment

List all keywords that describe your program: (e.g. kids, health fair, tour)
Program Date (select one)
Date Range    Begin   End
Recurring
Ongoing
Program Location (select one)
Select location to your program
Nationwide
Statewide
Multiple City or County-Wide
One Location

Facility
Street Address
City   Zip  State

Multiple Areas: (copy/paste zip codes or ask PBH for assistance in uploading multiple listings)
Program Expectations and Challenges
What are the expected outcomes of your program? (100 Words or less)

What are the biggest challenges of your program? (100 Words or less)

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