Healthy Living Practices Form

Please provide a brief summary of your project/program: Items for inclusion could be program components, program setting, and/or background for why your program was developed:

What is the overall goal of your project/program? Goals should include a problem statement and/or reason for program creation:

What strategies did you use to communicate about your project/program? Items for inclusion could be marketing/promotion techniques and/or participant recruitment/engagement and retention strategies:

Please share challenges and/or lessons learned from conducting your project/program, along with strategies for how you overcame them:

What were the results of your project/program? Items for inclusion could be information on how you evaluated program success and/or strategies you used, or plan to use, to share the results of your program:

Please provide any keywords you feel apply to your program:

LiveHealthyPA Healthy Living Practices - Disclaimer

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All submissions shall become the property of DOH and DOH may use such submissions in any manner DOH deems appropriate for purposes and maintenance of the LiveHealthyPA website.
The Pennsylvania Department of Health (DOH) has the sole and exclusive right to edit the text and resize any photos as needed.
DOH is under no obligation to publish your submission.
DOH may use your name, text image(s), and other uploaded materials as featured content in any medium whatsoever, including livehealthypa.com, any affiliate publication and in promotional and advertising and any derivative thereof, without cost or remuneration of any kind to the submitter.
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You agree to hold the Commonwealth of Pennsylvania (including DOH) its officers, agents and employees, harmless against any and all claims, demands and actions based upon or arising out of any activities, and shall, at the request of the Commonwealth, defend any and all actions brought against the Commonwealth based upon any such claims or demands arising from or in connection with any use of the submission, including text, images(s), and other uploaded materials.
You certify that you are 18 years of age or older.

Your submission will not be considered without the following information: Your Name, Address, Email and Telephone number.

I agree, please check the box

Healthy Living Practices Submission Form

Contact Information (Your contact information will be viewable to other users) Expand/Collapse

Upload files (pictures, brochures, flyers, etc.)

Organization Type

Healthy Living Practice (Your contact information will be viewable to other users) Expand/Collapse

Type of Practice: (Select all that apply)

Target Age Range (select all that apply)

Gender

Race/Ethnicity (select all that apply)

Counties Served (select all that apply)

Project Service Type: (Select all that apply)

Project/Program Content Area

Project/Program Care Team Target Population

LiveHealthyPA Healthy Living Practices - Disclaimer