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Question Title

* Institutional Information

Your name

Your title

Name of institution

Address line 1

Address line 2

City

State

Zip

Phone number

E-mail address

Institution’s web address

Please note: Only your institution’s name, address, and web address will be posted on the IMLS website. Your personal contact information will not be posted.

All institutions must select at least one of the first two priorities.

Question Title

* Priority #1: Eat healthy, get active exhibits (Click here for examples of exhibits.)

	We will do this.	We currently do this.	Not applicable to our institution.
Offer interactive experiences or exhibits that provide messages about healthy choices to visitors and to track our number of visitors.	Offer interactive experiences or exhibits that provide messages about healthy choices to visitors and to track our number of visitors. We will do this.	Offer interactive experiences or exhibits that provide messages about healthy choices to visitors and to track our number of visitors. We currently do this.	Offer interactive experiences or exhibits that provide messages about healthy choices to visitors and to track our number of visitors. Not applicable to our institution.

If you have responded "We currently do this,” please tell us a bit more about your exhibit(s):

Question Title

* Priority #2: Learning about healthy food choices and physical activity through afterschool, summer and other programs (Click here for examples of programs.)

	We will do this.	We currently do this.	Not applicable to our institution.
Offer afterschool, summer and other programs that include messages about healthy choices and to track our number of participants in such programs.	Offer afterschool, summer and other programs that include messages about healthy choices and to track our number of participants in such programs. We will do this.	Offer afterschool, summer and other programs that include messages about healthy choices and to track our number of participants in such programs. We currently do this.	Offer afterschool, summer and other programs that include messages about healthy choices and to track our number of participants in such programs. Not applicable to our institution.

If you have responded "We currently do this,” please tell us a bit more about your program(s):

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