Nutrition Education Services Request Form

Nutrition Education Services Request Form

For further questions or information, please contact our Nutrition Education Team at nutrition@ntfb.org.
Name of Agency*
Type of Agency/Affiliation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Contact on Day of Event*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Is at least 50% of your audience considered low-income?*

YesNo
Workshop Preference*

Virtual (Zoom)In-personEither
What criteria do you use to determine low-income eligibility?*
Skip to page...*
Page Descriptions:
- Material Requests = nutrition education handouts, recipes, posters, etc. for your organization
- Nutrition Education Workshops = series-based nutrition education lessons geared towards a variety of audiences (kids, adults, parents, seniors)
- Cooking Matters at the Store/Pantry = a nutritionist led grocery store tour at a grocery store near you/pantry tour with a short cooking demonstration taste test
- Healthy Pantry and Nudge Pantry Materials Request = nudges, nutrition education handouts, recipe cards, posters, etc. for your pantry
All resources are provided free of charge to any agency serving low-income audiences.

Cooking Matters at the Store

Please Note: Our grocery store tours are for Adults only
Requested Date

MonthDayYear
Requested Time of Event

:HourMinutesAM/PM Option
Number of Participants Expected (Be Realistic)
(Minimum: 6, Maximum: 15)
Language (If Other Than English)
**If you are a pantry, please skip next two questions and proceed to Cooking Matters in Your Pantry section below
Please Suggest a Grocery Store Located Near Participants
Physical Address of Store

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cooking Matters in Your Pantry (click to open)
Cooking Matters in Your Pantry

Cooking Matters in Your Pantry includes a short cooking demo/sampling session
Name of Pantry
Address of Pantry

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your agency have access to a space for cooking demonstrations (enough room for 1-2 small tables) and access to electrical outlets?

YesNo
What food item would you like to be included in the cooking demo/sample session?
(Ideally an item that clients are not selecting or are not familiar with.)

Material Requests