Fresh Fruits and Vegetable Training Registration Form: Modesto Spring 2013

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Thank you for your interest in the Fresh Fruits and Vegetables Seasonal Training scheduled for March 5th & 6th. The training will cover an engaging range of content to further enrich and stimulate you and your peer network toward fostering a healthy school environment.

Please provide us with the following information below. Our training facilitators will be sending you a confirmation email with linked details made available on http://www.healthyschoolenvironment.org/ in early February. Should you have any questions in advance please don't hesitate to contact your workshop facilitator, Jeri Ohmart at jlohmart@ucdavis.edu or the statewide project coordinator, Tim Galarneau at tgalarne@ucsc.edu.

First Name *

Last Name *

Name of your School or Organization *

Name of your School District, if relevant

County you work in *

List the county you primarily work in

Select your primary role in supporting a Healthy School Environment *

Check the best answer (we know it is hard to fit everything you do in one little box)

Educator - Garden Educator

Educator - Nutrition Educator

Food Service Professional

Farm to School Promoter

Teacher - Elementary (k-5)

Teacher - Secondary (6-12

Teacher - Preschool/daycare

Administrator - School, District or Business

Community Volunteer

Produce Grower/Marketer

Other:

Job Title *

Email *

Please check spelling for accuracy

Phone *

xxx-xxx-xxxx

Select workshop location: *

This form is for registering at the location below only. If the option below says "WAITLIST," then the workshop is full. Complete this registration form and we will contact you if space opens.

Modesto March 5th & 6th

Which days of the workshop will you be attending? *

Day One

Day Two

Both Days

Is your school a current Fresh Fruit and Vegetable Program Grant Recipient? *

yes

I don't know

Are you a Network for a Healthy California contractor or program? *

yes

I don't know

Is your agency a Shaping Health as Partners in Education (SHAPE) member? *

yes

I don't know

Have you attended a FFVCHSE Training(s) in the Past?

If you have attended a training in the past please list the training(s), if not leave blank. [2012 SPRING: Bakersfield - Fresno - Hayward - Los Angeles - East Palo Alto - Ukiah] __[2011 FALL: Bakersfield - Fresno - Hayward - Los Angeles - San Francisco - Ukiah] __ [2011 SPRING: Chico - Glendale - Merced - San Marcos - San Jose - San Luis Obispo - San Rafael - Ventura - Woodland] __ [2010 FALL: Chico - Glendale - Merced - San Marcos - San Jose - San Luis Obispo - San Rafael - Ventura - Woodland] __ [2010 SPRING: Davis - Downey - Fresno - Hayward - Redding - Rialto - Salinas - San Diego - Santa Ana - Santa Rosa] __ [2009 FALL: Davis - Downey - Fresno - Hayward - Redding - Rialto - Salinas - San Diego - Santa Ana - Santa Rosa]

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