This form is used to collect information about small food stores in North Carolina that are making efforts to offer healthier options and the organizations that are helping these stores. Please note: it is advised that you download and complete a paper copy of the Assessment Tool for Small Food Stores for your records prior to completing this online form.

This form can also be used as an application for the North Carolina Healthy Food Retail Designation. The designation recognizes small food stores that meet product criteria established by the North Carolina Healthy Food Retail Collaborative.
If you are working on healthy food retail efforts in a store with partners, please contact them to determine who should complete this form to avoid duplicate entries.
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