Ohio First Steps for Healthy Babies FATHER/PARTNER Application

1. SECTION 1: Hospital & Team Member Information

Please complete this application to be considered for Father/Partner Engagement Designation. This survey is intended for hospitals that do not need to newly apply or renew steps for First Steps designation at this time but would like to obtain Father/Partner Engagement Designation. Your hospital is eligible for Father/Partner Engagement Designation only for the steps that you are currently recognized.

Question Title

* Hospital Name

Question Title

* Complete Mailing Address

Question Title

* Hospital Breastfeeding Champion (may be different than the person completing this survey)

Name

Title

Phone Number