Breastfeeding-Friendly Campus Award Application
The Breastfeeding-Friendly Campus Award recognizes colleges and universities who support and protect the rights of all breastfeeding mothers, students, employees, and visitors on their campuses through guidelines, accommodations and an overall culture that recognizes the importance of helping mothers achieve their breastfeeding goals.

If you would like to apply for our Breastfeeding-Friendly Campus Award, please complete the items below.
College/University Name: *
Your answer
Address: *
Your answer
Contact name and position: *
Your answer
Contact number: *
Your answer
Contact email: *
Your answer
Website URL regarding lactation accommodations:
Your answer
Please email (below) or attach copies of the following items
1. How many formal lactation accommodations (spaces/rooms) does your campus currently have?
Your answer
2. How many informal lactation accommodations does your campus currently have?
Your answer
3. What amenities are included in your spaces?(Check all that apply)
4. Does your campus have a policy or practice whereby new and/or remodeled buildings are equipped with lactation spaces?
5. Does your campus have practices whereby lactation accommodations are provided within a five-minute walk anywhere on campus?
6. If you have identified breastfeeding champions, those who help your campus operate a shared responsibility model, please describe their responsibilities below
Your answer
A. How many breastfeeding champions do you have?
Your answer
7. Does your campus have a certified lactation consultant (CLC) or international board certified lactation consultant (IBCLC) that supports breastfeeding on campus?
8. Does your campus offer breastfeeding education and/or referral resources?
10. Do we have permission to promote your campus breastfeeding achievements? This likely would occur in the local print/TV media, in posts on the Connecticut Breastfeeding Coalition's website and social media accounts?
For further questions or information about the Breastfeeding-Friendly Campus Initiative and award please contact us at info@breastfeedingct.org or (203) 699-MILK
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