New Jersey Breastfeeding-Friendly Worksite Recognition Program
On-Line Self-Assessment/Application
Workplace Name *
Workplace Mailing Address *
Website URL
Point of Contact Name *
Point of Contact email *
Point of Contact phone *
Number of Employees
Select all supportive practices that apply
Your application will not be considered complete until you have sent a photo image of your lactation space to
Does the NJBC have permission to publish your workplace location and photos of your lactation space on our website, once your submission has been approved?
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I certify that the above criteria listed in this application for worksite recognition have been in effect for at least 6 months.
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