May 2024 HEZ Learning Community (in-person) Registration

Please register below for the May 2024 HEZ Learning Community taking place on Tuesday, May 14, 2024 at the Rhode Island College located at 600 Mount Pleasant Avenue in Providence, Rhode Island.

Question Title

* 1. General Information

First Name

Last Name

Email Address

Organization

Question Title

* 2. Affiliation (If you are affiliated with multiple HEZs, please select from the options listed below)

02907 HEZ

Blackstone Valley HEZ

Bristol HEZ

Central Providence Opportunities HEZ

OneCranston HEZ

East Providence HEZ

Healthy Bodies, Healthy Minds: The Washington County HEZ

Newport HEZ

Pawtucket Central Falls HEZ

South Providence HEZ

Tri-County HEZ

Warren HEZ

Warwick HEZ

West Warwick HEZ

Woonsocket HEZ

Rhode Island Department of Health

Executive Office of Health and Human Services

Other (If you are affiliated with multiple HEZs, please select them from the list above).

Question Title

* 3. Role within HEZ (Check all that apply)

HEZ Staff

Steering Committee Member

Collaborative Member

Resident

Partner Organization

RIDOH HEZ Staff

Other RIDOH Program Staff

EOHHS Staff

HEZ Training & Technical Assistance Program Sponsor

Other

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* 4. Reasonable accommodations for person(s) with disability with 2-week notice.

Please include the accommodation below and email Morgan.Duffney@health.ri.gov and Deb.Golding@health.ri.gov upon completion of this form.

Severe Food Allergies and Sensitivities

Breakfast Menu

Sliced Melon
Scrambled Eggs
Home Fried Potatoes
French Toast
Bacon
Muffins (Regular & Gluten-free)
Greek Yogurt
Coffee (Regular and Decaf)
Tea
Water
Orange Juice

Lunch Menu

Mixed Field Greens with choice of dressing
Chicken Picatta
Pasta Primavera
Rice Pilaf
Green Beans Almondine
Rolls and Butter
Cookie 3-Packs: Oatmeal, Chocolate Chip, and Sugar Cookies
Coffee (Regular and Decaf)
Infused water
Assorted Soft Drinks

Question Title

* 5. After reviewing the menu above, please use the space below to let us know of any severe allergies or sensitivities we should be aware of.

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* 6. Photo Release
By registering for this event I grant the State of Rhode Island permission to use my likeness in photograph(s)/video in any and all of its websites, publications, and in any and all other media. I will make no monetary or other claim against the State of Rhode Island for the use of the photograph(s)/video.

Por este medio autorizo al Departamento de Salud de Rhode Island para usar mi imagen en fotografía(s) y video(s) en cualquiera o todos sus sitios en el internet, publicaciones y cualquier otro medio de prensa. No haré ningun reclamo monetario al Departamento de Salud de Rhode Island por el uso de mi fotografía(s)/video.

Yes, I agree.

May 2024 HEZ Learning Community (in-person) Registration

Question Title

* 1. General Information

Question Title

* 2. Affiliation (If you are affiliated with multiple HEZs, please select from the options listed below)

Question Title

* 3. Role within HEZ (Check all that apply)

Question Title

* 4. Reasonable accommodations for person(s) with disability with 2-week notice. Please include the accommodation below and email Morgan.Duffney@health.ri.gov and Deb.Golding@health.ri.gov upon completion of this form.

Question Title

* 5. After reviewing the menu above, please use the space below to let us know of any severe allergies or sensitivities we should be aware of.

Question Title

Question Title

* 7. Please use the space below to share any questions you have.

* 4. Reasonable accommodations for person(s) with disability with 2-week notice.

Please include the accommodation below and email Morgan.Duffney@health.ri.gov and Deb.Golding@health.ri.gov upon completion of this form.