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Health Promotion
Council’s Nutrition and
Active Living Department

Operates a variety of services that target multiple levels of influence, settings, and strategies to promote healthy and sustainable habits. These include health promotion programs that focus on improving individual’s behavior through educational activities or other intrapersonal strategies, as well as systems and policy-change initiatives to ensure that communities have access to healthy food and safe places to be active.

Registration Form

Thank you for your interest in the virtual nutrition education offered by Health Promotion Council (HPC)! The following questions help HPC better understand who is taking the class. You can skip any question you do not want to answer.

Is this the first time you attended a SNAP-Ed nutrition education class provided by Health Promotion Council during this program year (since October 1, 2022)?

Yes No

Registration Form

What is your gender?

Male

Female

Prefer not to say

Please Select Gender

What is your age?

18 - 59

60 or older

Please Select Age

What is your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Please Select Ethnicity

What is your race? Check all that apply.

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaskan Native

Are there children under the age of 18 in your household?

Yes

Please Select children Under Age

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Registration Form

What is your zip code?

Please Enter Zip Code

What program site would you normally attend or are affiliated with?

Please Select Program Site

Who referred you to this virtual nutrition education?

The affiliated program site may
want to know the names of the individuals taking this virtual class.

Do you give HPC permission to share your name with a program site? No other identifying information such as phone number or email will be shared.

Yes, I permit HPC to share my name No, I do not permit HPC to share my name

Please Select Permission Box

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Registration Form

When possible, HPC provides small nutrition education-related supplies to class attendees who live within HPC’s mailing radius. Examples of these supplies are measuring cups, whisks, snack containers, salad shakers, and other items that are talked about during the virtual classes and recipe videos.

If such items are available, would you like to provide your mailing address so that HPC can send the item to you?

Yes No

Please Select Any

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Registration Form

Please provide the below information so that HPC can mail you the item, if available. At this time, HPC is only able to mail to addresses within its mailing radius.

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Registration Form

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Thank You

You have registered successfully. Click the link below to return to the website and log in using your email and password.

Address

Contact Information

Supplemental Nutrition Assistance Program

Health Promotion
Council’s Nutrition and
Active Living Department

About Us

Resources

Address

Contact Information

Supplemental Nutrition Assistance Program

Health Promotion Council’s Nutrition and Active Living Department

About Us

Resources

Registration

Registration Form

Registration Form

Registration Form

Registration Form

Registration Form

Registration Form

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Health Promotion
Council’s Nutrition and
Active Living Department