2017 Diabetes Cook-Off Submission Form
Please read through the official contest rules, eligibility requirements, and other information before submitting a recipe here:
Year of Birth
Primary Phone Number
Secondary Phone Number
(Optional) Has a doctor ever told you that you have Diabetes?
(Optional) If you were a participant in the South Side Diabetes Education class co-taught by Dr. Monica Peek, at what clinic did you have your class?
No, I did not participate
Primary Care Group / Kovler Diabetes Center (University of Chicago)
Access Booker Health Center
Access Grand B Family Health Center
Chicago Family Health Center
Friend Family Health Center
Recipe Categories (select one):
Be original and creative!
List the recipe ingredients – Remember to include measurements (Example: ½ cup of 1% milk or 2 carrots)
Please list no more than 8 ingredients: (Do not include spices, oils, and garnish in this section)
Please list spices, oils, and items for garnish and the amounts or measurements you need (these will not be counted with your 8 ingredients):
Please Note: garnishes can be used for plate presentation only and cannot be used to enhance the flavor of your dish.
List the step-by-step recipe directions.
What inspired you to cook healthy?
Send us a photo! (Optional)
We welcome all submissions to share a photo of the dish. This is not required.To submit a photo, please attach it in an email with your full name and the name of your recipe to:
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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