I. NOMINATED TEAM

Teams working in NJ from the SNAP-Ed Support Network are eligible.

Name of Project: *

Project Spokesperson: *

Spokesperson E-mail: *

Spokesperson Address: *

Spokesperson Address (cont.):

Spokesperson City: *

Spokesperson State: * --Select A State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Spokesperson Zipcode: *

Spokesperson Telephone: *

II. TEAM MEMBERS

Please list the team members involved with the project. If you need additional space, please include the names in the comments field below.

• Name

• Program Affiliation

III. NOMINATED TEAM CONTACT

Please enter the information for the contact person on the nominated team.

Contact: *

Position Title: *

Office Address: *

Office Address (cont.):

Office City: *

Office State: * --Select A State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Office Zipcode: *

Office Telephone: *

IV. RECOMMENDER

The recommender is the person who feels that this team deserves to be considered for the Team Acheivment Award.

Name:

Position Title:

Office Address

Office Address (cont.):

Office City:

Office State: --Select A State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Office Zipcode:

Office Telephone:

V. PROGRAM DESCRIPTION

Please provide the following information for the program:

Who was involved? i.e., students; parents; volunteers; school food service personnel; supermarket; community members; media or agencies.

What materials and activities were included? i.e. Train-the-Trainer program; health fair; supermarket; classroom or community education session.

Describe the program (limit to 1,000 words):

Where did it take place? i.e., classrooms; cafeteria; supermarket; homes; community center; farmer's market; church; doctor's office

What was the duration? i.e., hours; days; weeks; months; a year

What was the outcome/impact? i.e., increased consumption of fruits and vegetables; increased consumption of calcium-rich foods; improved diet recalls

Did this project address NJ SNAP initiatives? i.e., increased calcium and fruit and vegetable consumption and/or reducing nutrition-related diseases, such as obesity, diabetes, heart disease and cancer.

* - Denotes Required Field