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EatWell With Your Cultural Foods
12-Week Heritage for Health Nutrition and Culinary Program
Serious inquiries only! This program is offered as a scholarship valued at $1,000, provided at no cost to participants. Form should be completed in its entirety to be considered.
Name
Email
Phone
Birthday
City and State
Do you have a family history of Diabetes?
*
Yes
No
Have you ever been diagnosed with any of the following?
*
Pre-Diabetes
Type 1 Diabetes
Type 2 Diabetes
None of the Above
Please select your ethnicty
*
African American/Black
Asian American
Hispanic/ Latin American
Native American
Other
How did you hear about this program?
*
Required
Radio
In-Person Event
Email Newsletter
Social Media
Would you prefer in person or virtual nutrition classes?
*
In-Person
Virtual
No Preference
What day of the week is best for you to meet in the evenings?
*
Required
Tuesday
Thursday
Either is fine
Thanks for submitting!
Send
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