Wellness Initiative Submission Form
Thank you for taking the time to fill out the form below. You are being asked to submit further information because we believe you, the group you work for, or the members of your community have a nutrition or wellness program or initiative you would like to have highlighted within our report. We are asking that you submit information on the project or initiative you are currently working on or have previously implemented within your organization or community to The Harkin Institute for Public Policy and Citizen Engagement. The information you provide will be used to select the programs and initiatives we plan to highlight this coming year.

You have been contacted on behalf of The Harkin Institute for Public Policy and Citizen Engagement located at Drake University in Des Moines, Iowa. The mission of The Harkin Institute is to foster active and informed citizen engagement in public decision-making and public policy making through education and outreach that expands the knowledge and understanding among students, scholars, and the public. The Harkin Institute is founded on the premise that good public policy is best achieved when policymakers have access to high quality information, political processes are open and well-understood, and citizens are informed and active participants. To learn more, visit www.HarkinInstitute.org.

At The Harkin Institute, our goal is to facilitate collaborative, high-quality, nonpartisan, multi-disciplinary public policy research and analysis in the area of wellness and nutrition. As part of this goal, we are in the process of creating a report that will highlight various wellness and nutrition initiatives and programs throughout the country. We plan to share this report with people, communities, businesses, and legislators with the hope that these programs will help other groups implement their own wellness and nutrition programs within their communities and organizations.

Please submit your response to us by Wednesday, November 1st, 2017. If you have any questions contact Lyndi Buckingham-Schutt (lyndi.buckingham-schutt@drake.edu)

Email address
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CONTACT INFORMATION
Salutation (Mr., Mrs. Ms.)
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Last Name:
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First Name:
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Title:
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Email:
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Mailing Address:
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Work Phone:
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Cell/Home Phone:
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SUBMISSION INFORMATION
Name of the organization/agency/chamber of commerce and name of the program:
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Please describe the initiative or program:
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Please describe how the initiative or program advances wellness and/or nutrition in your community:
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Please list all relevant dates for upcoming and past initiatives:
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Please add any additional information:
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Please provide the link(s) to a website or another link to more information about your group:
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